How does the need for IVF affect pregnancy complications among multiple gestations? The study of a large American population database including almost 100,000 multiple gestations

Objective

This study's aim is to compare pregnancy outcomes in multifetal gestations that were conceived spontaneously compared to in vitro fertilization (IVF). Few population-based studies have addressed this topic.

Study design

This is a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database. Our study cohort included 90,552 multifetal gestations conceived spontaneously and 3219 IVF conceptions, from 2008 to 2014, inclusively. Multivariate logistic regression analyses were performed comparing maternal and neonatal outcomes, whilst adjusting for confounding variables. Subject was conducted using ICD-9 codes for multifetal gestation: 651. X and 76.1 and ICD-9 code for IVF: 23.85. Each pregnancy was included once.

Results and conclusion

IVF multifetal gestations had increased risk of pregnancy-induced hypertension (aOR 1.31, 95 % CI 1.20-1.43), gestational hypertension (aOR 1.21, 95 % CI 1.04-1.41), preeclampsia (aOR 1.31, 95 % CI 1.19-1.45), gestational diabetes (aOR 1.26, 95 % CI 1.13-1.41) and placenta previa (aOR 1.7, 95 % CI 1.32-2.19). IVF delivery outcomes were more likely complicated by cesarean section (aOR 1.21, 95 % CI 1.10-1.33), preterm premature rupture of membranes (aOR 1.33, 95 % CI 1.16-1.52), chorioamnionitis (aOR 1.71, 95 % CI 1.37-2.14), postpartum hemorrhage (aOR 1.44, 95 % CI 1.26-1.63) and transfusions (aOR 1.48, 95 %CI 1.26-1.74). IVF neonatal outcomes were more likely complicated by small for gestational age (aOR 1.26, 95 % CI 1.12-1.41) and congenital anomalies (aOR 1.82, 95 % CI 1.29-2.57). IVF was not found to increase risks of eclampsia, preterm delivery, operative vaginal delivery, hysterectomy, or intrauterine fetal demise.IVF increased the risk of pregnancy, delivery, and neonatal outcomes in multifetal pregnancies with risks increased from 20 % to 70 %. The role of infertility versus the need for IVF and the type of IVF protocol used should be further evaluated.

Prevalence and adverse outcomes of twin pregnancy in Eastern Africa: a systematic review and meta-analysis

INTRODUCTION

Multiple pregnancies are much more common today than they were in the past. Twin pregnancies occur in about 4% of pregnancies in Africa. Adverse pregnancy outcome was more common in twin pregnancy than in singleton pregnancy. There is no pooled evidence on the burden and adverse pregnancy outcome of twin pregnancy in eastern Africa. Thus, this systematic review and meta-analysis were conducted to assess the prevalence and adverse pregnancy outcomes of twin pregnancies.

METHODS

This systematic review and meta-analysis covers published and unpublished studies searched from different databases (PubMed, CINAHL (EBSCO), EMBASE, DOAJ, Web of Sciences, MEDLINE, Cochrane Library, SCOPUS, Google Scholar, and Google search). Finally, 34 studies were included in this systematic review and meta-analysis. JBI checklist was used to assess the quality of included papers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Data synthesis and statistical analysis were conducted using STATA Version 14 software. Heterogeneity and publication bias were assessed. A forest plot was used to present the pooled prevalence using the random effect model.

RESULTS

The prevalence of twin pregnancy in eastern Africa was 3% [95% CI: 2, 3]. The adverse pregnancy outcomes like neonatal intensive care unit admission (78%), low birth weight (44%), low APGAR score (33%), prematurity (32%), stillbirth (30%), neonatal mortality (12%) and maternal complications like hypertensive disorder of pregnancy (25%), postpartum hemorrhage (7%), Cesarean section (37%), premature rupture of membrane (12%) and maternal mortality are more common among twin pregnancy than singleton pregnancy.

CONCLUSION

One in every 33 children born a twin in east Africa; admission to neonatal intensive care unit, low birth weight, low APGAR score, prematurity, stillbirth, neonatal mortality and maternal complications are its associated adverse birth outcomes. Since twin pregnancy is a high-risk pregnancy, special care is needed during pregnancy, labor and delivery to reduce adverse pregnancy outcomes.

First case of dichorionic diamniotic triplet pregnancy after single blastocyst transfer

Multiple pregnancies are associated with significant maternal, fetal, and neonatal risks, including prematurity, low birth weight, pre-eclampsia, anemia, postpartum hemorrhage, intrauterine growth restriction, neonatal morbidity, and increased neonatal and infant mortality rates. Assisted reproductive technology (ART) treatments should prioritize efforts to reduce such events, resisting patient demand for the transfer of multiple embryos at each transfer to increase success rates. Extended culture, embryo selection, and single blastocyst transfer can mitigate the risk of high-order multiple pregnancies. Intriguingly, elective single-embryo transfer (eSET) greatly reduces, but does not completely eliminate, the likelihood of multiple gestations. The occurrence of monozygotic twinning (MZT) gives rise to identical twins. It is more prevalent in women undergoing in vitro fertilization (IVF) compared with natural conception. In fact, the reported risks of monozygotic twinning in IVF and natural conception are 1.7 and 0.4%, respectively. The factors suspected to increase the risk of MZT in IVF are multiple embryo transfer, micromanipulation, and extended in vitro culture. Determining chorionicity and amnionicity is crucial in the assessment of multiple pregnancies during the first-trimester ultrasound examination. Dichorionic twins result from embryo splitting within 3 days after fertilization, while monochorionic twins occur when the splitting takes place between 4 and 8 days after fertilization. These timings are suggested by observations carried out in natural pregnancies. In ART, there is evidence of dichorionic twins derived from single embryo transfer (SET). Here, we report a case of dichorionic diamniotic triplets after a single blastocyst transfer occurred in our center. To our knowledge, this is the first case documented so far.

Maternal and Neonatal Outcomes in Twin Deliveries with Prolonged Second-Stage Duration of the Presenting Twin: a Retrospective Cohort Study

To assess the risk of adverse maternal and neonatal outcomes as a function of the presenting twin second-stage duration. A retrospective cohort study of deliveries taking place in an academic medical center between 2005 and 2019. The study group included women with twin pregnancies with the first fetus in vertex presentation, who attempted vaginal delivery with epidural analgesia and attained the second stage of labor. Prolonged second stage (PSS) was defined as when exceeding the 95th percentile of presenting twin second-stage duration recorded among all parturients who achieved spontaneous vaginal deliveries in our center during the study period, stratified by parity: 3 h in nulliparas and 1 h in multiparas. Women with and without PSS were compared. The primary outcome was a composite of adverse maternal outcomes. A univariate analysis was conducted and followed by multivariate analysis. During the study period, 1,337 parturients (36% of twin deliveries) met study criteria, of these 22% (298) were nulliparous and 78% (1,039) were multiparous. The second stage of labor of the presenting twin was prolonged in 41 (13.8%) of the nulliparas and 64 (6.2%) multiparas. Prolonged second stage was associated with episiotomy, chorioamnionitis, endometritis, and blood product transfusion, as well as vacuum deliveries of the first and second twin, second-stage cesarean, and a higher rate of composite adverse maternal outcome in nulliparous (41.5% vs. 20.2%, p<0.01) and with higher rates of episiotomy, postpartum hemorrhage, and vacuum deliveries of the first and second twin, but a similar rate of composite adverse maternal outcome in multiparous women (7.8% vs. 9.3%, p=0.68); moreover, the composite adverse neonatal outcome was not increased in nulliparous (36.6% vs. 38.5%, p=0.81) nor in multiparous women (21.9% vs. 23.6%, p=0.75). Prolonged second stage of labor of the presenting twin was associated with an adverse composite maternal outcome in nulliparous and with postpartum hemorrhage in multiparous. Further larger studies are warranted to reinforce our findings.

Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

OBJECTIVE

This meta-analysis aimed to assess the efficacy of antenatal corticosteroids (ACS) on morbidity and mortality among preterm multiple pregnancies.

METHODS

The PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies investigating the outcomes among preterm multiple gestations following to ACS, from their inception to 1 November 2020. Two authors independently performed the study selection, risk of bias assessment and data extraction. The primary outcomes were respiratory distress syndrome (RDS) and mortality and secondary outcomes included intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), necrotising enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Pooled ORs were obtained using random effects models. Subgroup analyses were performed to explain heterogeneity by ACS completeness, administration-to-delivery intervals (≤7 days) and single or multicentre.

RESULTS

A total of 16 observational studies with 36 973 newborns were included in the meta-analysis. ACS treatment was associated with a reduction in RDS (OR 0.66; 95% CI 0.54 to 0.82; I2=91.4%; p<0.001), mortality (OR 0.64; 95% CI 0.50 to 0.81; I2=85.9%; p<0.001), IVH (OR 0.67; 95% CI 0.54 to 0.83; I2=77.4%; p<0.001) and PVL (OR 0.65; 95% CI 0.47 to 0.92; I2=75.5%; p<0.001). Subgroup analyses showed ACS completeness, administration-to-delivery interval and multicentre study affected these associations.

DISCUSSION

ACS may be beneficial for reducing the risks of RDS, mortality, IVH and PVL among preterm multiple gestations. The efficacy of ACS could be affected by ACS completeness and administration-to-delivery. More robust evidence on the efficacy of ACS treatment among multiple gestations is warranted.

Diagnostic performance of the noninvasive prenatal FetoGnost RhD assay for the prediction of the fetal RhD blood group status

Purpose

To evaluate the diagnostic accuracy of a commercially available test kit for noninvasive prenatal determination of the fetal RhD status (NIPT-RhD) with a focus on early gestation and multiple pregnancies.

Methods

The FetoGnost RhD assay (Ingenetix, Vienna, Austria) is routinely applied for clinical decision making either in woman with anti-D alloimmunization or to target the application of routine antenatal anti-D prophylaxis (RAADP) to women with a RhD positive fetus. Based on existing data in the laboratory information system the newborn’s serological RhD status was compared with NIPT RhD results.

Results

Since 2009 NIPT RhD was performed in 2968 pregnant women between weeks 5 + 6 and 40 + 0 of gestation (median 12 + 6) and conclusive results were obtained in 2888 (97.30%) cases. Diagnostic accuracy was calculated from those 2244 (77.70%) cases with the newborn’s serological RhD status reported. The sensitivity of the FetoGnost RhD assay was 99.93% (95% CI 99.61–99.99%) and the specificity was 99.61% (95% CI 98.86–99.87%). No false-positive or false-negative NIPT RhD result was observed in 203 multiple pregnancies.

Conclusion

NIPT RhD results are reliable when obtained with FetoGnost RhD assay. Targeted routine anti-D-prophylaxis can start as early as 11 + 0 weeks of gestation in singleton and multiple pregnancies.

Retrospective evaluation of attempted vaginal deliveries in dichorionic twin pregnancies

Purpose

Numbers of planned cesarean deliveries are increasing in twin pregnancies, despite the lack of evidence for this approach, and the second twin is thought to be at risk for a poorer outcome. The aim of this study was to examine whether twins have a poorer outcome if an attempted vaginal delivery is changed to a cesarean section or combined delivery.

Methods

This retrospective data analysis included all women with dichorionic twin pregnancies attempting vaginal delivery over a 10-year period. Outcome parameters for the first and second twins relative to their mode of birth were compared. A correlation model between the interdelivery time interval and Apgar scores was calculated. Subgroup analyses assessing the birth mode of the first and second twins were conducted.

Results

A total of 248 women were enrolled in the study. The second twins had significantly lower values for outcome parameters, such as umbilical artery cord pH and Apgar scores in comparison with the first twins (P < 0.01). The subgroup analysis of birth modes in first and second twins showed a significantly poorer outcome in the cesarean section and combined delivery group (P < 0.05). The interdelivery time interval was significantly longer in the second twin cesarean section group (P < 0.01). There was no significant correlation between the interdelivery time intervals and Apgar scores (P > 0.05).

Conclusion

Although outcome parameters were significantly lower in second twins and twins born via secondary cesarean section, the clinical relevance of this appears to be negligible.

Effects of the timing of selective reduction and finishing number of fetuses on the perinatal outcome in triplets: a single-center retrospective study

OBJECTIVE

This study aimed to evaluate the effect of the timing of selective reduction and finishing the number of fetuses on perinatal outcomes in triplets.

METHOD

The study assessed 417 cases of triplets. Perinatal outcomes were compared between selective reduction (SR) performed at 11-14⁺⁶weeks of gestation and SR performed at 15-24⁺⁶weeks of gestation for the same starting and finishing numbers of fetuses. Then, the perinatal outcomes of reduction to singletons and twins were compared for the same range of SR of gestational weeks.

RESULTS

The spontaneous abortion rate was 6.5% and 14.9%, respectively, when SR was performed at 11-14⁺⁶weeks of gestation (214 cases) and at 15-24⁺⁶ weeks of gestation (94 cases) (p = .019). In total, 74 cases of triplets were reduced to singletons and 214 cases were reduced to twins when SR was performed at 11-14⁺⁶weeks of gestation. Preterm labor rates, low birth weight rates, birth weights, and gestational ages at delivery also showed significant differences (p < .001). In total, 35 cases of triplets were reduced to singletons and 94 cases were reduced to twins when SR was performed at 15-24⁺⁶weeks of gestation. The preterm labor rates, low birth weight rates, birth weights and gestational ages at delivery also significantly differed (p < .05).

CONCLUSIONS

When the starting and finishing numbers of fetuses were the same, the timing of SR could affect the spontaneous abortion rates. When the starting number of fetuses was the same, the timing of SR did not affect the neonatal outcome. However, the finishing number of fetuses was the influencing factor.

Vacuum extraction in twin deliveries-maternal and neonatal consequences: a retrospective cohort study

PURPOSE

To establish the frequency of vacuum extraction among parturients with twin pregnancies, identify the risk factors and perinatal outcomes.

METHODS

A retrospective cohort database study was conducted between 2005-2018. Twin fetuses with vertex presentation >34 weeks gestation who achieved vaginal delivery were included. Outcomes were compared between neonates who were delivered by vacuum extraction and neonates delivered by spontaneous vaginal delivery (aORs; [95% CI]).

RESULTS

A total of 1751 neonates of 905 parturients with twin pregnancies met inclusion criteria, of which 163 (18%) parturients had vacuum extraction and 225 (12.8%) neonates were delivered by vacuum extraction. The most significant risk factors for vacuum extraction were primiparity (6.79 [4.77-9.66]), previous cesarean delivery (5.59 [3.13-9.97]), and epidural analgesia (4.34 [1.83-10.31]). Vacuum extractions were associated with a spectrum of adverse maternal outcomes (2.60 [1.61-4.19]), particularly postpartum hemorrhage and its associated morbidities. From the neonatal aspect, vacuum extraction deliveries were associated with a composite of birth trauma injuries (21.81 [6.43-73.91]).

CONCLUSION

Vacuum extractions among twin pregnancies were found to be associated with significantly higher rates of postpartum hemorrhage, blood transfusion, and perinatal birth trauma. These findings should be presented to women when counseling on mode of delivery and considered individually against cesarean delivery disadvantages.

The impact of chorionicity and assisted reproductive therapies in obstetric and neonatal outcomes

Objective: Multiple gestations' incidence have raised worldwide in the last years, much due to assisted reproductive therapies (ART). The goal of this study was to analyze obstetric and neonatal outcomes of twin pregnancies in a level 3 maternity.Methods: A retrospective study including all twins born in a period of 12 years in a level 3 maternity was conducted. Analysis comparing spontaneous monochorionic and dichorionic twins and spontaneous and ART dichorionic twins were performed. A p value < .05 was considered statistically significant.Results: The sample included 1783 newborns from 875 mothers. Mean maternal age was 31 years, with 616 spontaneous pregnancies and 259 through ART. Prematurity occurred in 77%. Congenital malformations were found in 6%, and the mortality rate was 3%. Monochorionic twins had higher prematurity (79% vs 72%) and very low birthweight (VLBW) rate (19% vs 14%). Congenital anomalies (9% vs 6%), Respiratory Distress Syndrome (23% vs 18%), patent ductus arteriosus (7% vs 4%), anemia (11% vs 5%), periventricular hemorrhage (5% vs 3%), mechanical ventilation (16% vs 10%) and mortality (4% vs 2%) were higher in monochorionic twins. Although congenital malformations were more frequent in the ART group, the difference was not statistically significant. The effect of ART in neonatal and obstetric outcomes was related to maternal age.Conclusion: Monochorionic pregnancies were associated with worst obstetric and neonatal outcomes. Although congenital malformations were more frequent in the ART group, the difference was not statistically significant. Most obstetric and neonatal complications were related to advanced maternal age.

The impact of cross-border IVF on maternal and neonatal outcomes in multiple pregnancies: Experience from a UK fetal medicine service

OBJECTIVES

To determine whether women seeking NHS care for IVF multiple pregnancies were more likely to have sought IVF treatment overseas and whether this was associated with different maternal and neonatal outcomes.

STUDY DESIGN

A single large tertiary centre, for perinatal care in northwest London. Sixty-five women were referred to our fetal medicine centre, between 2012-2016, with IVF conceived multiple pregnancies.

INCLUSION CRITERIA

In Vitro fertilisation and conception of twins/ triplets/quadruplets.

EXCLUSION CRITERIA

Intra-uterine insemination, ovulation induction, Clomid-conception and singleton pregnancies. The primary outcome measure was the Country where IVF treatment was performed. The secondary outcomes measures included the specifics of IVF treatment (e.g. number of embryos transferred), subsequent pregnancy outcomes (e.g. live-births and prematurity) and neonatal outcomes (e.g. length and cost of care).

RESULTS AND CONCLUSION

Thirty-eight women had IVF overseas; they were older and had more pre-existing medical conditions. Eleven pregnancies used donor embryos, of which ten were from overseas treatment. 75% of women treated overseas conceived a triplet or higher order pregnancy compared to fewer than 10% of women who conceived in the UK. Almost half of all women treated overseas had more than two embryos transferred. Overseas IVF pregnancies had poorer obstetric and neonatal outcomes: 24% of live born babies died in the neonatal period compared to 0% in the UK group. The average neonatal costs per baby born from overseas IVF were £20, 600: two-and-a-half times higher than for those whose mothers conceived in the UK. Higher order multiple pregnancies are greatly over-represented by those undergoing IVF in overseas clinics. These are associated with poorer obstetric and neonatal outcomes. Perhaps paradoxically, improving NHS provision of fertility services might improve outcomes for the mother and babies while reducing the long-term burden to both fertility patients and the NHS.

The prediction of preterm delivery: What is new?

Preterm birth, defined as birth occurring prior to 37 weeks gestation, is a serious obstetric problem accounting for 11% of pregnancies worldwide. It is associated with significant neonatal morbidity and mortality. Predictive tests for preterm birth are incredibly important, given the huge personal, economic, and health impacts of preterm birth. They can provide reassurance for women who are unlikely to deliver early, but they are also important for highlighting those women at higher risk of premature delivery so that we can offer prophylactic interventions and help guide antenatal management decisions. Unfortunately, there is unlikely to be a single test for predicting preterm birth, but a combination of tests is likely to improve clinical prediction. This review explores the clinical utility of the currently marketed predictive tests for preterm birth in both singleton and multiple pregnancies, as well as discussing novel predictive tests that may be useful in the future.

Multiple pregnancies and air pollution in moderately polluted cities: Is there an association between air pollution and fetal growth?

BACKGROUND

Multiple pregnancies (where more than one fetus develops simultaneously in the womb) are systematically excluded from studies of the impact of air pollution on pregnancy outcomes. This study aims to analyze, in a population of multiple pregnancies, the relationship between fetal growth restriction (FGR), small for gestational age (SGA) and exposure to air pollution in moderately polluted cities.

METHODS

All women with multiple pregnancies living in the city of Besançon or in the urban area of Dijon and who delivered at a university hospital between 2005 and 2009 were included. FGR and SGA were obtained from medical records. Outdoor residential nitrogen dioxide (NO₂) exposure was assessed using the mother's address, considering a 50 m radius buffer over the following defined pregnancy periods: each trimester, entire pregnancy and two months before delivery. Logistic regression analyses were performed.

RESULTS

This study included 249 multiple pregnancies with 506 newborns. The median of NO₂ concentration considering a 50 m radius buffer during entire pregnancy was 23.1 μg/m³ (minimum at 10.1 μg/m³ and maximum at 46.7 μg/m³). No association was observed between NO₂ and SGA whatever the pregnancy period (the odds ratio (OR) range 0.78 to 0.88). Regarding FGR, the OR associated with an increase of 10 μg/m³ of NO₂ exposure during entire pregnancy was 1.52 (95% Confidence Interval (CI): 1.02-2.26). Similar results were observed for NO₂ exposure during the various pregnancy periods.

CONCLUSIONS

These results are in line with an association between NO₂ and fetal growth in multiple pregnancies for an exposure mostly below the threshold set out in European legislation.

Comparison of different types of twin pregnancies in terms of obstetric and perinatal outcomes: association of vanished twins with methylenetetrahydrofolate reductase (MTHFR) polymorphism(s)

PURPOSE

Vanished twin (VT) has been associated with poor perinatal outcomes. Our research aimed to investigate the outcomes of pregnancies with vanished twin and its possible association with methylenetetrahydrofolate reductase (MTHFR) polymorphisms.

METHODS

This study consisted of 30 of 38 VT pregnancies (group 1, VT group), 109 singletons (group 2), 70 spontaneous twins (group 3), and 101 in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) twins (group 4).

RESULTS

Most patients in group 1 (28/30) were tested for MTHFR genes (C677T or A1298C polymorphisms). Eight of the 38 pregnancies with VT (21.1%) resulted in miscarriage. The prevalence of "2 or more pregnancy losses" in the "obstetric history" in group 1 was higher (23.3%) than those in the other groups (p = 0.007, χ² = 17.8). The allelic frequencies of MTHFR 677 and MTHFR 1298 in group 1 were 0.268 and 0.429, respectively (higher than those in healthy population). The median birthweights in groups 1, 2, 3, and 4 were 2940, 3200, 2300, and 2095 g, respectively. The prevalence of respiratory distress syndrome was significantly higher in the IVF/ICSI twin pregnancy group (p < 0.001, χ² = 21.2). Early pregnancy loss and the presence of "2 or more miscarriages" in the obstetric history of pregnancies with VT were more frequent.

CONCLUSION

The coincidence of VT and MTHFR polymorphisms might play an incidental or factual role in this connection.

[Evaluation of pelvic floor function of postpartum pelvic floor ultrasound in pregnant women with multiple pregnancies]

Objective: To probe the effect of multiple pregnancy on pelvic floor function of pregnant women, Pelvic floor ultrasonography was performed on the 42 day postpartum women.And the bladder neck mobility, bladder and urethral posterior angle and pelvic diaphragmatic hiatus area were measured. Methods: Collect 200 cases 42 day postpartum women who visited the second hospital of Jilin University from July 2015 to June 2017, of which 100 cases of primipara belong to group A, 100 cases of multiple pregnancy belong to group B, and 100 cases without maternal at the same age belong to the control group, ultrasound measurement of the bladder neck mobility, bladder and urethral posterior angle and pelvic diaphragmatic hiatus area were measured.t test were proformed respectively between the three groups, P<0.05 was considered statistically significant difference. Results: In the control group, the bladder neck mobility is (2.59±0.51) cm , the bladder neck mobility in A group is (2.99±0.69) cm, the bladder neck mobility in B group is (3.36±0.71) cm; the bladder and urethral posterior angle in the control group is (112.56±13.61)°, the bladder and urethral posterior angle in the control group after Valsalva action angle is(135.37±12.17)°, the bladder and urethral posterior angle in A group is(119.26±15.80)°, the bladder and urethral posterior angle in group A after Valsalva action is(141.79±12.08)°, the bladder and urethral posterior angle in B group is(123.62±16.20)°, the bladder and urethral posterior angle in group B after Valsalva action is (148.92±13.60)°; the pelvic diaphragmatic hiatus area in the control group is (13.35±2.86) cm(2,) the pelvic diaphragmatic hiatus area in the control group after Valsalva action is(15.28±3.15) cm(2,) the pelvic diaphragmatic hiatus area in A group is(17.52±3.19) cm(2,) the pelvic diaphragmatic hiatus area in A group ater Valsalva action is (18.06±5.13_the pelvic diaphragmatic hiatus area) cm(2,) the pelvic diaphragmatic hiatus area in B group is (18.26±4.18) cm(2,) the pelvic diaphragmatic hiatus area in B group after Valsalva action is (20.3±3.53) cm(2).In group A, group B and the control group, the measured value of the bladder neck mobility, bladder and urethral posterior angle and pelvic diaphragmatic hiatus area were examined by t test, and P<0.05, which means the difference was statistically significant. Conclusion: Pregnancy can affect the function of female pelvic floor, and the effect of parturient is more significant than that of the primipara.

Introduction: Biomarkers of embryo viability: the search for the "holy grail" of embryo selection

Over the past four decades we have witnessed great progress and increasing pregnancy success rates with in vitro fertilization. However, this apparent success has been accompanied by the burden of multiple pregnancies. While efforts to reduce the number of embryos transferred have had a salutary impact on the incidence of high order multiple pregnancies, twin gestations have not diminished significantly. Thus, the search for a marker of embryo quality with the goal of selecting the single best embryo for transfer continues to be the major challenge facing our field. The four contributions in this Views and Reviews present several contemporary approaches, both invasive and non-invasive, for evaluating embryo viability. Each group makes the case that recent techniques, including time-lapse microscopy, biomechanical markers for oocytes and embryos, novel non-invasive methods of evaluating embryo metabolism and function as well as measurement of mitochondrial DNA, will allow the identification of the single best embryo for transfer. They describe several promising markers of embryo viability, although the goal of finding the "holy grail" of embryo selection has not yet been realized.

Analysis of the main risk factors for gestational diabetes diagnosed with International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria in multiple pregnancies

INTRODUCTION

The aim is to investigate the proportion of multiple pregnancies with gestational diabetes mellitus (GDM) diagnosed using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and to identify the impact of age, body mass index (BMI), and mode of conception on incidence of GDM.

MATERIALS AND METHODS

This is a single center, retrospective cohort study on 656 multiple pregnancies screened for GDM with 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation, between January 2010 and January 2016. The diagnosis of gestational diabetes mellitus (GDM) was reached through the IADPSG.

RESULTS

The incidence of GDM in our population was 15.1%. When patients who conceived through heterologous assisted reproduction technology were compared with those who conceived spontaneously, there was a significant difference for GDM (31.1 vs 13.6%, p < 0.001, OR 2.86). A similar finding was also observed comparing egg donation IVF/ICSI patients with homologous IVF/ICSI patients (31.1 vs 14.8%, p = 0.006, OR 2.59). Incidence of GDM was significantly higher in obese than in non-obese patients (42.5 vs 14.8%, p < 0.001, OR 4.88) and in women over 35 compared to younger patients (18.4 vs 11.1%, p = 0.01, OR 1.81). Logistic regression comparing the diabetes onset with conception mode gave a p = 0.07. The calculation of the Chi-square and odds ratio for single mode of conception showed that homologous vs conceived spontaneously p = 0.90, OR 0.97, heterologous vs homologous p = 0.01 with OR 2.46, and heterologous vs conceived spontaneously p = 0.01 with OR 2.39. Logistic regression showed that age and BMI are risk factors for developing GDM, respectively, p = 0.03 with OR 1.4 and p < 0.01 and OR 1.09.

DISCUSSION

The contribution our study can make is improved counseling about GDM risks for couples with multiple pregnancies. Our data support the role of age, BMI, and mode of conception as risk factors for GDM in multiple pregnancies.

Outcomes of elective cryopreserved single or double embryo transfers following failure to conceive after fresh single embryo transfer

The main adverse effect of IVF is the high multiple pregnancy rate resulting from the transfer of two or more embryos. The objective was to evaluate pregnancy rates in infertile women with a good prognosis who failed to conceive in a fresh elective single embryo transfer (eSET) and had a second cycle with elective double vitrified-warmed embryo transfer (eDFET) compared with elective single vitrified-warmed embryo transfer (eSFET). A total of 142 intracytoplasmic sperm injection cycles using a conventional protocol were evaluated. Good-prognosis patients underwent eSET in a fresh cycle, and those who failed to conceive underwent a second vitrified-warmed embryo transfer: eDFET (n = 102) or eSFET (n = 40). Embryos were transferred and vitrified on day 5 of development. Patients who received eDFET had fewer implantations (30.9%) than eSFET (52.5%; P = 0.004); pregnancy rates were similar (eDFET: 35.3%, eSFET: 42.5%). Patients with the eSFET had one monozygotic twin (5.9%), and 22.2% of eDFET patients had multiple pregnancies. Patients with a good prognosis who failed to conceive in the first fresh eSET did not have an advantage when receiving eDFET in the second cycle, as pregnancy rates were similar; 22.2% of patients in the eDFET group had multiple pregnancies.

Genetics: update on prenatal screening and diagnosis

There have been tremendous advances in the ability to screen for the "odds" of having a genetic disorder (both mendelian and chromosomal). With microarray analyses on fetal tissue now showing a minimum risk for any pregnancy being at least 1 in 150 and ultimately greater than 1%, it is thought that all patients, regardless of age, should be offered chorionic villus sampling/amniocentesis and microarray analysis. As sequencing techniques replace other laboratory methods, the only question will be whether these tests are performed on villi, amniotic fluid cells, or maternal blood.

Impact of the Number and Quality of Embryos Transferred in Multiple and Single Pregnancies

OBJECTIVE

To investigate the relation between maternal age and embryo quality in choosing how many embryos should be transferred to obtain high pregnancy rates with minimal risk of multiple gestations.

METHODS

Cross-sectional study, with secondary data analysis, including infertile couples undergoing Intracytoplasmic Sperm Injection, between 2005-2013, in the Assisted Fertilization Center - Fertility. The data was analyzed using the SPSS 16.0, in a descriptive and bivariate way using the chi-square test, P <0.05. Approved by the CEP UNISUL.

RESULTS

54.8% of pregnancies occurred with women ≤ 35 years. The prevalence of single pregnancy was 2.42 times the multiple pregnancies and no significant increase in multiplicity in the transfer of 3 or 4 embryos. The percentage of positive pregnancies was prevalent in the age group ≤ 35 years, regardless of embryo quality. Regardless of age, the greater the number of high quality transferred embryos, the higher the multiplicity. This was not observed with low-quality embryos. With high quality embryos, the prevalence of positive pregnancies in middle age women was 9% lower when compared to those aged ≤ 35 years, with a P = 0,310. With low-quality embryos, the prevalence of positive pregnancy in this age group was 39% lower when compared to those aged ≤ 35 years, with a P < 0.01.

CONCLUSION

The greater the number of high quality transferred embryos, the higher the multiplicity. However, this relationship is not true for low quality embryos. When only high quality embryos are transferred, the patients with intermediate age have similar pregnancy results to those from younger patients. Already with low-quality embryos, this same age group presents similar pregnancy results to older patients.