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Bhusal A, Yogi TN, Budthapa J, Katwal S, Mahat A. Anencephaly in a triplet pregnancy: Unprecedented spontaneous reabsorption in-utero and subsequent normal delivery via c-section: A rare case report. Radiol Case Rep 2024; 19:2826-2831. [PMID: 38689815 PMCID: PMC11059298 DOI: 10.1016/j.radcr.2024.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 05/02/2024] Open
Abstract
Multiple pregnancies are infrequently encountered, with the incidence of spontaneous triplet pregnancies estimated at approximately 1 in 7000 pregnancies. Triplet gestations are recognized for their propensity to bring about a spectrum of pregnancy related complexities, encompassing fetal structural abnormalities, neurological anomalies, disturbances in amniotic fluid levels, preterm labor, and suboptimal neonatal outcomes. Anencephaly is a serious congenital defect where the brain and skull do not fully develop, often leading to a poor prognosis. It's a preventable neural tube defect (NTD) with timely intake of folic acid, is caused by the incomplete closure of the neural tube during fetal development, resulting in the absence of the cerebrum (responsible for thinking and coordination) and the front part of the brain (forebrain) in affected infants. While anencephaly in a triplet is scarcely reported, spontaneous reabsorption of an anencephalic fetus in utero is a rare and unexpected event, with no documented cases in triplet pregnancies until now. We report a case of anencephaly in a triplet pregnancy where the mother presented late during her third trimester, the reabsorption of the anencephalic fetus in utero is an unprecedented event, highlighting the unique nature of this triplet pregnancy.
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Affiliation(s)
- Amrit Bhusal
- Department of Radio-diagnostics and Imaging; BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Tek Nath Yogi
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Jwala Budthapa
- Department of Radio-diagnostics and Imaging; BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | | | - Asim Mahat
- Department of Radiodiagnosis and Imaging; Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Banafshi Z, Khatony A, Jalali A, Jalali R. Exploring the lived experiences of women with multiple gestations in Iran: a phenomenological study. BMC Pregnancy Childbirth 2024; 24:203. [PMID: 38491430 PMCID: PMC10941611 DOI: 10.1186/s12884-024-06384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/01/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Multiple gestations present numerous physical, psychological, social, and economic challenges for women. Understanding the problem-solving experiences of pregnant women carrying multiple can be invaluable. This study aimed to explore the experiences of Iranian women with multiple gestations. METHODS This descriptive phenomenological study utilized purposive sampling and continued until data saturation. Data collection involved in-depth semi-structured interviews, with analysis performed using Colaizzi's 7-step method. MAXQDA software was employed for data management. RESULTS This study involved 12 women with multiple gestations. The average age of the participants was 33.76 ± 6.22 years, and 9 were pregnant with triplets. The data were categorized into four primary themes: the paradox of emotions, the pregnancy prison, immersion in fear, and the crystallization of maternal love, encompassing 17 sub-themes. CONCLUSION Pregnant women with multiple gestations undergo various changes and experience conflicting emotions. Enhancing their ability to adapt to and accept numerous pregnancies can be achieved through supportive, personalized, and family-centered care, along with improvements and revisions in care policies for multiple gestations.
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Affiliation(s)
- Zhina Banafshi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Amir Jalali
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Ye A, Liu X. Clinical value of high-intensity focused ultrasound in fetal reduction. Eur J Obstet Gynecol Reprod Biol 2024; 294:206-209. [PMID: 38295709 DOI: 10.1016/j.ejogrb.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
Complex twin reduction surgery is a common but challenging procedure that aims to reduce the risks and complications of multiple pregnancies. The search for safer and more effective methods has led to the development of high-intensity focused ultrasound (HIFU) technology in the field of fetal reduction. This technology utilizes high-energy sound waves to focus precisely on specific areas, achieving non-invasive therapeutic effects. This paper discusses the principles and features of HIFU technology, as well as its application in complex twin reduction surgery. The paper aims to elucidate the important role of this technology in improving surgical outcomes and reducing risks, explore the current limitations of the modality, and propose directions for future development. Through these investigations, it is hoped to improve overall understanding of HIFU, and thereby promote the application of this technology in the field of fetal reduction.
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Affiliation(s)
- Aihua Ye
- Department of Obstetrics and Gynaecology, The Maternal and Child Health Hospital of Longhua District, Shenzhen, Guangdong, China
| | - Xinhong Liu
- Department of Obstetrics and Gynaecology, The Maternal and Child Health Hospital of Longhua District, Shenzhen, Guangdong, China.
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Wind M, Dekker L, van den Akker-van Marle ME, Ballieux BEPB, Cobbaert CM, Rabelink TJ, van Lith JMM, Teng YKO, Sueters M. The addition of the sFlt-1/PlGF ratio to the protein/creatinine ratio in multiple pregnancy: Post-hoc analysis of the PREPARE cohort study. Pregnancy Hypertens 2024; 36:101111. [PMID: 38387424 DOI: 10.1016/j.preghy.2024.101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/14/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To assess the predictive accuracy of the sFlt-1/PlGF ratio cut-off 38 in addition to the standard-of-care spot urine protein/creatinine ratio (PCr) for multiple pregnancies in women with suspected pre-eclampsia. STUDY DESIGN Post-hoc analysis of a prospective cohort study. MAIN OUTCOME MEASURES Primary outcome was the occurrence of pre-eclampsia in one and four weeks after presentation with suspected pre-eclampsia. Test characteristics with 95% confidence intervals (CI) were calculated on pre-eclampsia development in one and four weeks. RESULTS Twenty-three multiple pregnancies with suspected pre-eclampsia between 20 and 37 weeks gestation were included for analysis. Women who eventually developed pre-eclampsia had a significantly higher PCr (34.0 vs. 16.5, p = 0.015), sFlt-1 (17033 vs. 5270 pg/ml, p = 0.047) and sFlt-1/PlGF ratio (99 vs. 25, p = 0.033) at baseline. Furthermore, PCr ≥ 30 and sFlt-1/PlGF ratio > 38 was respectively seen in 1/16 (6.3 %) and 3/16 (18.8 %) of the women who did not develop pre-eclampsia. For predicting pre-eclampsia within one week the sFlt-1/PlGF ratio sensitivity was 75.0 % [95 % CI 19.4-99.4] and the negative predictive value 93.8 % [73.0-98.8], while no pre-eclampsia developed when PCr was < 30. Consequently, the combination of these tests did not lead to an improvement in test characteristics, with non-significant differences in positive predictive value (50.0 % [29.5-70.5] versus 80.0 % [37.3-96.4]) compared to PCr alone for pre-eclampsia development in one week. CONCLUSIONS In addition to standard-of-care spot urine PCr measurements, this study has not been able to demonstrate that the sFlt-1/PlGF ratio cut-off 38 is of added value in the prediction of pre-eclampsia in multiple pregnancy. TRIAL REGISTRATION Netherlands Trial Register (NL8308).
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Affiliation(s)
- M Wind
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
| | - L Dekker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - B E P B Ballieux
- Department of Clinical Chemistry, Leiden University Medical Centre, Leiden, the Netherlands
| | - C M Cobbaert
- Department of Clinical Chemistry, Leiden University Medical Centre, Leiden, the Netherlands
| | - T J Rabelink
- Department of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J M M van Lith
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Y K O Teng
- Department of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M Sueters
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
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Seetho S, Kongwattanakul K, Saksiriwuttho P, Thepsuthammarat K. Epidemiology and factors associated with preterm births in multiple pregnancy: a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:872. [PMID: 38110899 PMCID: PMC10726547 DOI: 10.1186/s12884-023-06186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE Multiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births in multiple pregnancies within the Thai population. This study aims to ascertain maternal and perinatal outcomes and identify factors linked to preterm births in multiple pregnancies. METHODS This study was carried out at Khon Kaen University, Faculty of Medicine, Department of Obstetrics and Gynecology in Thailand. We reviewed the medical records of women with multiple pregnancies who delivered at a gestational age of more than 20 weeks between January 1, 2012 and December 31, 2021. We excluded patients with incomplete data or those for whom data were missing. RESULTS Out of 21,400 pregnancies, 427 were multiple pregnancies, constituting approximately 1.99%. Over the ten-year period, 269 multiple pregnancies (65.1%) resulted in preterm births. Of these, 173 (64.3%) were monochorionic twins, and 96 (35.7%) were dichorionic twins. Monochorionic twins had a notably higher rate of preterm delivery (AOR, 2.06; 95%CI 1.29-3.30). Vaginal delivery was observed in 7.9% of the cases, while cesarean sections were performed for both twins in 91.5% of cases. In 0.5% of the cases, only the second twin was delivered by cesarean section. In terms of neonatal outcomes, 160 infants (19.4%) weighed less than 1,500 g at birth, and there were 78 perinatal deaths (9.4%). Birth asphyxia was noted in 97 cases (20.2%) among monochorionic twins and in 28 cases (8.1%) for dichorionic twins. CONCLUSION The prevalence of multiple pregnancies was 1.99%, with 65.1% resulting in preterm births. Neonatal complications were notably more frequent in monochorionic twins. Monochorionic placenta and antepartum complications emerged as significant risk factors for preterm birth.
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Affiliation(s)
- Samita Seetho
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kiattisak Kongwattanakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Piyamas Saksiriwuttho
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Vidal Pimentel B, Tsoutsoulas C, Lythgoe K, Myslik F. Optimizing Care for High-Risk Multiple Pregnancy with POCUS - A Case of Quadruplet Pregnancy Early Diagnosis. POCUS J 2023; 8:126-128. [PMID: 38099167 PMCID: PMC10721298 DOI: 10.24908/pocus.v8i2.16562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Managing multiple pregnancies is challenging and requires careful evaluation. Point of care ultrasound (POCUS) has emerged as a potentially crucial tool in assessing suspected first-trimester pregnancies. However, its role in evaluating multiple pregnancies remains uncertain. We present the case of a 36-year-old Ghanaian female who presented with acute vaginal bleeding after undergoing in vitro fertilization. A bedside transabdominal POCUS identified four intrauterine gestations with fetal poles and cardiac activity, suggesting a quadruplet viable pregnancy. A subsequent transvaginal ultrasound confirmed the findings. The patient was discharged with a follow-up appointment with an Obstetrician-Gynecologist. This case highlights the significance of POCUS in early pregnancy diagnosis, facilitating accurate identification and appropriate referral for further management. It also demonstrates the utility of POCUS in determining gestational age and viability. To our knowledge, no published case reports specifically address the diagnosis of a quadruplet pregnancy, emphasizing the role of POCUS in optimizing care for high-risk multiple pregnancies.
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Affiliation(s)
| | - Christopher Tsoutsoulas
- Division of Emergency Medicine, Department of Medicine, University of TorontoToronto, OntarioCanada
- North York General HospitalToronto, OntarioCanada
| | - Kristin Lythgoe
- Division of Emergency Medicine, Western UniversityLondon, OntarioCanada
- London Health Sciences CentreLondon, OntarioCanada
| | - Frank Myslik
- Division of Emergency Medicine, Western UniversityLondon, OntarioCanada
- London Health Sciences CentreLondon, OntarioCanada
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Shinohara S, Horiuchi S, Shinohara R, Otawa S, Kushima M, Miyake K, Yui H, Kojima R, Ooka T, Akiyama Y, Yokomichi H, Yamagata Z. Multiple pregnancy as a potential risk factor for postpartum depression: The Japan Environment and Children's Study. J Affect Disord 2023; 329:218-224. [PMID: 36849005 DOI: 10.1016/j.jad.2023.02.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/10/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Postpartum depression (PPD) results in adverse consequences for both mother and infant. However, the association between multiple pregnancy and PPD is unknown because of the difference in the estimated prevalence rate of PPD based on country, ethnicity, and study type. Thus, this study aimed to determine whether Japanese women with multiple pregnancy were at a high risk of developing PPD at 1 and 6 months postpartum. METHODS In this nationwide prospective cohort study (the Japan Environment and Children's Study), conducted between January 2011 and March 2014, 77,419 pregnant women were enrolled. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS) 1 and 6 months postpartum. A score of ≥13 points implied "positive" for PPD. Multiple logistic regression analyses estimated the association between multiple pregnancy and PPD risk. RESULTS Overall, 77,419 pregnancies (singleton, n = 76,738; twins, n = 676; triplets, n = 5) were included; 3.6 % and 2.9 % of pregnant women had PPD at 1 and 6 months postpartum, respectively. Compared with singleton pregnancy, multiple pregnancy was not associated with PPD at 1 month, but at 6 months postpartum (adjusted odd ratios: 0.968 [95 % confidence interval {CI}, 0.633-1.481] and 1.554 [95 % CI, 1.046-2.308], respectively). LIMITATIONS 1) Some potential PPD risk factors could not be evaluated, 2) PPD was not diagnosed by psychiatrists, and 3) depressive symptoms at 6 months postpartum were considered PPD; however, definitions may vary. CONCLUSIONS Japanese women with multiple pregnancy may be regarded as a target group for follow-up and postpartum depression screening for at least 6 months during the initial postpartum period.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506, Japan.
| | - Sayaka Horiuchi
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Kunio Miyake
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Hideki Yui
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Reiji Kojima
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Tadao Ooka
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Yuka Akiyama
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan; Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
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Gent J, Oliver E, Quigley H, Sharp A. Effectiveness of dinoprostone gel, misoprostol vaginal insert and dinoprostone vaginal insert for induction of labour in twin pregnancies. Eur J Obstet Gynecol Reprod Biol 2023; 286:23-27. [PMID: 37167810 DOI: 10.1016/j.ejogrb.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To compare the effectiveness and safety of Dinoprostone Gel (DG), Misoprostol Vaginal Insert (MVI) and Dinoprostone Vaginal Insert (DVI) for induction of labour (IOL) in twin pregnancies. STUDY DESIGN Retrospective cohort study of twin pregnancies > 34 + 0 weeks gestation that underwent induction of labour (IOL) with DG, MVI or DVI between December 2016 and November 2019 in a Tertiary NHS hospital, North West England, UK. Delivery characteristics, maternal complications and neonatal outcomes were compared between the three groups. RESULTS A total of 87 twin pregnancies were included for analysis. 27 women received DG, 34 received MVI and 26 DVI. The MVI cohort had a higher proportion of nulliparous women (55.9%) compared to the DG and DVI cohorts, 29.6% and 38.5% respectively. No other differences amongst demographic characteristics were considered clinically significant. DG demonstrated a significantly quicker time to delivery (minutes) compared to DVI (1021 ± 556 versus 1649 ± 852; P = 0.0026). Significantly fewer women required terbutaline for hyperstimulation/tachysystole in the DG group compared to MVI (0% vs 32%; RR 0.05; 95% CI 0.003-0.88). Both DG and MVI groups required significantly less oxytocin following artificial rupture of membranes compared to DVI (33% vs 65%; RR 0.51; 95% CI 0.28-0.93) and (29% vs 65%; RR 0.45; 95% CI 0.25-0.81). There were no significant differences in mode of delivery, maternal complications and neonatal outcomes. CONCLUSION Our data suggests that for women with a twin pregnancy considering a planned labour that induction with DG, MVI and DVI appear to be equally safe and effective IOL methods. These results should be interpreted with caution due to the study being underpowered to detect significant adverse outcomes. In order to determine the optimal method of IOL in twins, direct randomised comparison is needed.
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Affiliation(s)
- J Gent
- Harris-Wellbeing Research Centre, University of Liverpool, United Kingdom.
| | - E Oliver
- University of Liverpool, United Kingdom
| | - H Quigley
- University of Liverpool, United Kingdom
| | - A Sharp
- Harris-Wellbeing Research Centre, University of Liverpool, United Kingdom
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Galati G, Esposito G, Somigliana E, Muzii L, Franchi M, Corrao G, Parazzini F. Trends in the incidence of major birth defects after assisted reproductive technologies in Lombardy Region, Northern Italy. J Assist Reprod Genet 2023; 40:857-863. [PMID: 36763300 DOI: 10.1007/s10815-023-02732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
PURPOSE The incidence of birth defects is increased in children born after assisted reproductive technologies (ART). However, changes in ART over time could influence this incidence. To investigate this issue, we present the frequency and trends of birth defects in ART and natural pregnancies in Lombardy, Northern Italy, during the period 2014-2020. METHODS This is a population-based study using automated system of healthcare utilization (HCU) databases. ART pregnancies included only those obtained with conventional IVF or ICSI. After identifying the total number of deliveries, the rate of newborns with birth defects was compared between natural and ART pregnancies. A logistic regression model was used to calculate the adjusted odd ratio (OR). Analyses were repeated for every calendar year. RESULTS Overall, 508,421 deliveries were identified, of which 14,067 (2.8%) were achieved after IVF-ICSI. A decreasing trend in birth defects over time was highlighted. The adjusted OR dropped from 1.40 (95%CI: 1.03-1.91) in 2014 to 0.92 (95%CI: 0.69-1.22) in 2020. During the study period, a significant reduction in multiple pregnancy and in the ratio of ICSI to conventional IVF was also observed, explaining at least in part the positive trend observed for birth defects. CONCLUSION The increased risk of birth defects in children born after IVF-ICSI is not steady over time. A decline of this risk emerged in our region. Policy changes in ART may explain this beneficial effect.
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Affiliation(s)
- Giulia Galati
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Giovanna Esposito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. .,Department of Obstetrics, Gynecology and Neonatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Franchi
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Giovanni Corrao
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Obstetrics, Gynecology and Neonatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Lawrenz B, Melado L, Fatemi HM. Ovulation induction in anovulatory infertility is obsolete. Reprod Biomed Online 2023; 46:221-4. [PMID: 36167631 DOI: 10.1016/j.rbmo.2022.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
Women with polycystic ovary syndrome make up the vast majority of patients with anovulatory infertility. The commonly accepted treatment guidelines recommend ovulation induction for timed intercourse as the first-line treatment. After a 2-year treatment period, the cumulative pregnancy rates with a singleton live-born baby reached 71% and 78% in two prospective studies. Despite aiming for monofollicular growth, multifollicular responses with subsequent multiple/higher order multiple pregnancies are a dreaded risk associated with ovarian induction. However, the lengthy treatment, the increase of maternal age and the psychological effects of 'obligatory intercourse' are also factors challenging the concept of ovarian induction as the first treatment approach in anovulatory infertility. Nowadays, individualized IVF treatment with cycle segmentation, freeze-all strategies and single-embryo transfers in frozen embryo transfer cycles dramatically reduces the risk of multiple pregnancies, and a cumulative pregnancy rate of 83% can be achieved over three complete cycles, thereby reducing exposure to fertility medication and time to pregnancy. Although on first sight ovarian induction might present the easier and less costly approach, efficient and individualized IVF treatments with low complication rates and the chance of preventing multiple pregnancies challenge this concept, and it seems that the time has come to abandon ovarian induction in anovulatory infertility.
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Vaajala M, Liukkonen R, Ponkilainen V, Kekki M, Mattila VM, Kuitunen I. Higher odds of gestational diabetes among women with multiple pregnancies: a nationwide register-based cohort study in Finland. Acta Diabetol 2023; 60:127-130. [PMID: 36219255 PMCID: PMC9813100 DOI: 10.1007/s00592-022-01984-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/27/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The association between multiple pregnancies and the risk of gestational diabetes mellitus (GDM) has been moderately studied. The aim of this study is to evaluate whether women with multiple pregnancies are at a higher risk of developing GDM using nationwide high-quality registers. MATERIALS AND METHODS In this retrospective cohort study, data from the National Medical Birth Register (MBR) was used to evaluate the odds of GDM as a result of multiple pregnancies. We included all pregnancies with a tested GDM recorded in the MBR between 2004 and 2018. A total of 397,810 pregnancies were included in this study. Logistic regression model was used to assess the odds for GDM among multiple pregnancies, when compared to singleton pregnancies. Odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) between the groups were compared. The model was adjusted with maternal BMI and in vitro fertilisation (IVF) treatments. RESULTS A total of 5825 multiple pregnancies and a tested GDM were observed. In the control group, there were 391,985 singleton pregnancies with a tested GDM. Of these, 1791 (30.7%) multiple pregnancies were associated with a diagnosis of GDM. GDM was more common among women with multiple pregnancies (30.7 vs. 25.9%, aOR 1.28; CI 1.21-1.36). CONCLUSION The results of this study show that women with multiple pregnancies have a higher odds of developing GDM and should be monitored to prevent the development of GDM.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Rasmus Liukkonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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张 红, 杨 蕊, 杨 硕, 潘 宁, 王 琳, 李 蓉. [Clinical effect of fetal reduction by intracranial and intrathoracic KCl injection]. Beijing Da Xue Xue Bao Yi Xue Ban 2022; 54:943-947. [PMID: 36241237 PMCID: PMC9568394 DOI: 10.19723/j.issn.1671-167x.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of fetal reduction by transabdominal intracranial KCl injection for multifetal pregnancies in the early second trimester. METHODS The data of 363 patients who underwent transabdominal fetal reduction in the Reproductive Medical Center of Peking University Third Hospital from January 2006 to December 2019 were analyzed retrospectively. According to the location of fetal reduction, they were divided into two groups: Intracranial injection group (n=196) and intrathoracic injection group (n=167). The process of fetal reduction and pregnancy outcome of the two groups were compared. RESULTS There was no significant difference between the two groups in the average age and the proportion of type of infertility before assisted reproductive technology, conception method, indication for fetal reduction, starting number of fetuses, reduced number of fetuses, and finishing number of fetuses (P>0.05). There was no significant difference between the two groups in the proportion of the number of puncture ≥ 2 times (12.1% vs. 8.6%, P=0.249) and the incidence of replacing puncture site (10.7% vs. 6.4%, P=0.161). The next day after fetal reduction, color Doppler ultrasound was rechecked. In the intracranial injection group and intrathoracic injection group, the incidence of fetal heartbeat recovery [3.6% (8/224) vs. 1.1% (2/187), P=0.188], the volumes of KCl used [(2.6±1.0) mL vs. (2.8±1.1) mL, P=0.079], and the abortion rate within 4 weeks after fetal reduction (1.0% vs. 0.6%, P=0.654) were of no significant difference. In addition, there was no significant difference in the total abortion rate after fetal reduction, premature delivery rate, cesarean section rate, delivery gestational week and neonatal birth weight between the two groups (P>0.05). CONCLUSION Intracranial KCl injection can be an effective alternative to intrathoracic KCl injection for multifetal pregancy reduction.
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Affiliation(s)
- 红霞 张
- />北京大学第三医院生殖医学中心, 北京 100191Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - 蕊 杨
- />北京大学第三医院生殖医学中心, 北京 100191Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - 硕 杨
- />北京大学第三医院生殖医学中心, 北京 100191Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - 宁宁 潘
- />北京大学第三医院生殖医学中心, 北京 100191Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - 琳琳 王
- />北京大学第三医院生殖医学中心, 北京 100191Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - 蓉 李
- />北京大学第三医院生殖医学中心, 北京 100191Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
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Scaravelli G, Pisaturo V, Levi Setti PE, Ubaldi FM, Livi C, Borini A, Greco E, Villani MT, Coccia ME, Revelli A, Ricci G, Fusi F, Costa M, Migliorati E, De Luca R, Vigiliano V, Bolli S, Reschini M. Monozygotic twin rate among ART centers: a multicenter analysis of data from 18 Italian units. J Assist Reprod Genet 2022; 39:2349-2354. [PMID: 36053372 PMCID: PMC9596663 DOI: 10.1007/s10815-022-02603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE The risk of monozygotic twins (MZTs) is increased in couples undergoing assisted reproductive technology (ART) treatments. Several systematic reviews have investigated the possible determinants linked to ART, but results obtained have not been conclusive. The study aims to investigate whether the incidence of MZT differed among ART centers. METHODS This is a multicenter retrospective cohort study using the Italian ART National Registry database and involving the centers reporting data from individual ART cycles from 2015 to 2019. To investigate the incidence of MZT, only single embryo transfer cycles were considered. Women who had sex-discordant deliveries were excluded. MZT rate was calculated as the number of multiple pregnancies (more than one gestational sac at first ultrasound) out of the total number of clinical pregnancies. A binomial distribution model was used to determine the 95% CI of the frequency of MZT. RESULTS Eighteen centers were included, and they provided data on 10,433 pregnancies. The total number of MZT was 162, corresponding to an incidence of 1.5% (95% CI: 1.3-1.8%). The rate of MZT among centers varied between 0% (95% CI: 0.0-25.9%) and 3.2% (95% CI: 1.3-8.1%). All the 95% CIs included 1.5%, rejecting the hypothesis that the MZT rate may significantly differ among centers. CONCLUSIONS The rate of MZT did not significantly vary among ART centers. Local factors are unlikely to explain the increased rate of MZT in ART pregnancies.
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Affiliation(s)
- Giulia Scaravelli
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Valerio Pisaturo
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti 6, 20122, Milan, Italy.
| | - Paolo Emanuele Levi Setti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Claudia Livi
- Demetra GeneraLife Assisted Procreation Center, Florence, Italy
| | | | - Ermanno Greco
- Villa Mafalda, Rome, Italy
- UniCamillus, International Medical University, Rome, Italy
| | - Maria Teresa Villani
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Alberto Revelli
- Gynecology and Obstetrics 1U/2U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Torino, Turin, Italy
| | - Giuseppe Ricci
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesco Fusi
- Department of Maternal Fetal and Pediatric Medicine, ASST, Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Costa
- Department of Reproductive Medicine, Ospedale Evangelico Internazionale, Genoa, Italy
| | - Emanuela Migliorati
- Surgery for Gynecology and Obstetrics, Genera Umbria S.R.L, Umbertide, Perugia, Italy
| | - Roberto De Luca
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Vincenzo Vigiliano
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Simone Bolli
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti 6, 20122, Milan, Italy
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Wen JY, Liu CF, Chung MT, Tsai YC. Artificial intelligence model to predict pregnancy and multiple pregnancy risk following in vitro fertilization-embryo transfer (IVF-ET). Taiwan J Obstet Gynecol 2022; 61:837-846. [PMID: 36088053 DOI: 10.1016/j.tjog.2021.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To decrease multiple pregnancy risk and sustain optimal pregnancy chance by choosing suitable number of embryos during transfer, this study aims to construct artificial intelligence models to predict the pregnancy outcome and multiple pregnancy risk after IVF-ET. MATERIALS AND METHODS From Jan 2010 to Dec 2019, 1507 fresh embryo transfer cycles contained 20 features were obtained. After eliminating incomplete records, 949 treatment cycles were included in the pregnancy model dataset and 380 cycles in the twin pregnancy model dataset. Six machine learning algorithms were used for model building based on the dataset which 70% of the dataset were randomly selected for training and 30% for validation. Model performances were quantified with the area under the receiver operating characteristic curve (AUC), accuracy, specificity, and sensitivity. RESULTS Models built with XGBoost performed best. The pregnancy prediction model produced accuracy of 0.716, sensitivity of 0.711, specificity of 0.719, and AUC of 0.787. The multiple pregnancy prediction model produced accuracy of 0.711, sensitivity of 0.649, specificity of 0.740, and AUC of 0.732. CONCLUSIONS The AI models provide reliable outcome prediction and could be a promising method to decrease multiple pregnancy risk after IVF-ET.
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Affiliation(s)
- Jen-Yu Wen
- Center for Reproductive Medicine, Depart of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Fen Liu
- Center for Big Medical Data and AI Computing, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Ting Chung
- Center for Reproductive Medicine, Depart of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yung-Chieh Tsai
- Center for Reproductive Medicine, Depart of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan; Department of Sport Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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15
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Sanseverino PB, Hoffmann A, Machado S, Farias M, Michels MS, Sanseverino MTV, Marostica PJC. High-risk twin pregnancy: case report of an adolescent patient with cystic fibrosis and systemic lupus erythematosus. J Med Case Rep 2022; 16:230. [PMID: 35641986 PMCID: PMC9153143 DOI: 10.1186/s13256-022-03399-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background We present the first case to our knowledge of a spontaneous twin pregnancy in a 16-year-old Caucasian patient with cystic fibrosis and systemic lupus erythematosus. Cystic fibrosis is one of the most common autosomal recessive genetic disorders and primarily affects the respiratory and digestive systems. Systemic lupus erythematosus is a chronic inflammatory disease of unknown cause that affects nearly every organ. Patients with cystic fibrosis or systemic lupus erythematosus are progressively having longer life expectancy and better quality of life, which has led a greater number of female patients reporting the desire to become mothers. Case presentation We present a case of a Caucasian 16-year-old pregnant with twins being treated for both cystic fibrosis and systemic lupus erythematosus. She has two CFTR mutations: p.F508del and 1812_1G>A. In the second trimester, she was admitted for possible preterm labor, which was successfully stopped. The patient’s nutritional status worsened, and she had a pulmonary exacerbation as well as a flare of systemic lupus erythematosus. At the 28th gestational week, she presented with a massive hemoptysis episode. The cesarean delivery had no complications, and there were no serious immediate postpartum complications. Discussion and conclusions While adolescent pregnancies in and of themselves are considered high risk for both the young mothers and their children, they are further complicated when the mother has two chronic diseases and a twin pregnancy. We achieved positive results using a multidisciplinary approach; however, the risks involved were so high that major efforts are to be taken by our medical community to prevent unplanned pregnancies in all patients with cystic fibrosis, especially when a serious comorbidity like the one in this case is present.
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Affiliation(s)
- Paula Baptista Sanseverino
- Universidade Federal do Rio Grande do Sul-PPG Saúde da Criança e do Adolescente, Ramiro Barcelos 2400 /sala 220, Atanásio Belmonte 515/502, Porto Alegre, RS, 90520550, Brazil.
| | - Anneliese Hoffmann
- Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350 /sala 1131, Porto Alegre, Brazil
| | - Sandra Machado
- Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, Brazil
| | - Mariana Farias
- Universidade Federal do Rio Grande do Sul-PPG Saúde da Criança e do Adolescente, Ramiro Barcelos 2400 /sala 220, Atanásio Belmonte 515/502, Porto Alegre, RS, 90520550, Brazil
| | - Marcus Silva Michels
- Universidade Federal do Rio Grande do Sul-Serviço de Genética HCPA, Ramiro Barcelos 2350, Porto Alegre, Brazil
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Abstract
Infertility treatments have benefited millions of couples to have their own children; however, the complication of multiple pregnancies with their increased morbidity and mortality has created significant problems. Fetal reduction (FR) was developed to ameliorate these issues. Over 30 years of publications show that FR has been highly successful in substantially reducing both mortality and morbidity. As with most radically new techniques, initial cases were in the "nothing to lose" category. With experience, indications liberalize, and quality of life issues increase as a proportion of cases. Overall risks for twins are not twice as those for singletons, but they are approximately 4- to 5-fold higher. In experienced hands, the combination of genetic testing by CVS followed by FR has made most multiples behave statistically as if they were originally the lower number. The use of microarray analysis to better determine fetal genetic health before deciding on which fetus(es) to keep or reduce further improves pediatric outcomes. With increasing experience and lower average starting numbers, the proportion of FRs to a singleton has increased considerably. Twins to a singleton FR now constitute an increasing proportion of cases performed. Data on such cases show improved outcomes, and we believe FR should be at least discussed and offered to all patients with a dichorionic twin pregnancy or higher. eSET is not a panacea because of the resultant monochorionic twins.
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Affiliation(s)
- Mark I Evans
- Fetal Medicine Foundation of America, USA; Comprehensive Genetics, PC, New York, USA; Department of Obstetrics & Gynecology, Icahn School of Medicine at Mt. Sinai New York, USA.
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Caballero-Reyes M, Medina-Rivera D, Alas-Pineda C, Mejía-Raudales B, Gaitán-Zambrano K, Valle Rubí T. Quadruple term gestation of quadri-chorionic quadri-amniotic pregnancy after artificial insemination: a case report. Reprod Health 2022; 19:97. [PMID: 35449065 PMCID: PMC9027892 DOI: 10.1186/s12978-022-01400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background To solve infertility, modern science has promoted assisted reproduction techniques such as in vitro fertilization, ovulation induction, and artificial insemination. Quadruple-type multiple pregnancies occur in 1 of every 500,000 pregnancies, and it is estimated that 90% occur due to assisted reproductive techniques, which often lead to numerous complications. Case presentation Here we present a case of a 33-year-old woman, who desired pregnancy, but had a history of primary infertility diagnosed by hysterosalpingography, and endometriosis, which was treated by fulguration and medical management. Concomitantly, the patient was anovulatory. To fulfill her wish, she underwent homologous artificial insemination, after treatment, she successfully conceived quadri-chorionic quadri-amniotic infants, who were born at 37.2 weeks, without perinatal or maternal complications. Conclusion This paper presented the parameters of prenatal care, appropriate management approach, and successful resolution without maternal–fetal complications despite the inherent risks of this type of pregnancy. Infertility is a common reproductive system problem; modern science has promoted assisted reproduction techniques as an alternative for these cases. High-order pregnancies it is estimated to occur in 90% of the cases due to assisted reproductive techniques, which often lead to numerous complications. A 33-year-old woman, who desired pregnancy, but had a history of infertility underwent artificial insemination, conceiving successfully quadruplets without any perinatal or maternal complications. Knowledge of maternal history and proper management of assisted reproductive techniques in addition to adequate prenatal follow-up are necessary for a successful pregnancy.
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Affiliation(s)
| | | | - César Alas-Pineda
- Departamento de Epidemiología, Hospital Dr. Mario Catarino Rivas, San Pedro Sula, Cortés, Honduras. .,Facultad de Medicina y Cirugía, Universidad Católica de Honduras - Campus San Pedro y San Pablo, San Pedro Sula, Cortés, Honduras.
| | - Beatriz Mejía-Raudales
- Facultad de Medicina y Cirugía, Universidad Católica de Honduras - Campus San Pedro y San Pablo, San Pedro Sula, Cortés, Honduras
| | - Kristhel Gaitán-Zambrano
- Facultad de Medicina y Cirugía, Universidad Católica de Honduras - Campus San Pedro y San Pablo, San Pedro Sula, Cortés, Honduras
| | - Tesla Valle Rubí
- Instituto Hondureño de Seguridad Social, San Pedro Sula, Cortés, Honduras
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Francisco C, Gamito M, Reddy M, Rolnik DL. Screening for preeclampsia in twin pregnancies. Best Pract Res Clin Obstet Gynaecol 2022; 84:55-65. [PMID: 35450774 DOI: 10.1016/j.bpobgyn.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/13/2022] [Indexed: 11/02/2022]
Abstract
Twin pregnancies are an important risk factor for preeclampsia, a hypertensive disorder of pregnancy that is associated with a significant risk of maternal and perinatal morbidity. Given the burden of preeclampsia, the identification of women at high risk in early pregnancy is essential to allow for preventive strategies and close monitoring. In singleton pregnancies, the risk factors for preeclampsia are well established, and a combined first-trimester prediction model has been shown to adequately predict preterm disease. Furthermore, intervention with low-dose aspirin at 150 mg/day in those identified as high-risk reduces the rate of preterm preeclampsia by 62%. In contrast, risk factors for preeclampsia in twin pregnancies are less established, the proposed screening models have shown poor performance with high false-positive rates, and the benefit of aspirin for the prevention of preeclampsia is not clearly demonstrated. In this review, we examine the literature assessing prediction and prevention of preeclampsia in twin pregnancies.
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Affiliation(s)
- Carla Francisco
- Department of Obstetrics and Gynaecology, Hospital Beatriz Ângelo, Avenida Carlos, Teixeira 3, 2674-514 Loures, Portugal.
| | - Mariana Gamito
- Department of Obstetrics and Gynaecology, Hospital Beatriz Ângelo, Avenida Carlos, Teixeira 3, 2674-514 Loures, Portugal.
| | - Maya Reddy
- Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, Melbourne, Victoria, Australia.
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, Melbourne, Victoria, Australia.
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Abstract
Vanishing twin syndrome (VTS), defined by first-trimester spontaneous loss of a twin, is a common phenomenon with a reported prevalence of 15-35% of twin pregnancies. The etiology of VTS is obscure. Still, several risk factors have been identified, including an increased number of embryos transferred in pregnancies conceived by in vitro fertilization, an initial increased number of gestational sacs and advanced maternal age. The effect of VTS on obstetric and perinatal outcomes is controversial. Several studies have reported that pregnancies with VTS were associated with increased risk for preterm birth and small for gestational age neonates compared to singleton pregnancies, while others showed no difference in perinatal outcomes. The prevalence of placental vascular and anatomic abnormalities such as small placentas was higher in VTS. These findings lay an essential foundation for understanding how this phenomenon affects obstetric and perinatal outcomes of the surviving pregnancy.
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Affiliation(s)
- Linoy Batsry
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Yinon
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
It is more than thirty years that perinatologists and healthcare personnel aim to reduce the morbidity associated with multiple pregnancy. In many cases, these complications stem from pregnancies achieved through artificial reproductive technologies (ART). Although dramatic measures have been taken to control those risks by increasing the proportion of single embryo transfers, the multiple pregnancy rate still remains relatively high among patient conceived through ART, carrying risks to both mothers and newborns, and is coupled with the related economic burden associated with prematurity. The aim of this review is to provide the current evidence regarding single embryo transfer to assist decision-makers and to promote patient knowledge toward an elective policy to reduce the risk of twinning. Single embryo transfer may aid in the further reduction of multiple pregnancy and, in most cases, will maintain patient autonomy and right of choice.
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Affiliation(s)
- Yuval Fouks
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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21
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging of complications following treatment with assisted reproductive technology: keep on your radar at each step. Abdom Radiol (NY) 2022; 47:328-40. [PMID: 34535828 DOI: 10.1007/s00261-021-03245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/07/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
Since the advent of assisted reproductive technology (ART), the utilization of ART procedures has become increasingly popular among women seeking to establish pregnancy. Radiologists are therefore likely to encounter the various complications of ART therapy. The most common is ovarian hyperstimulation syndrome; others are multiple, ectopic, and heterotopic pregnancies. Ultrasonography is considered the initial modality to investigate ART complications, However, nonspecific symptoms might need the use of an additional imaging modality, such as computed tomography or magnetic resonance imaging, as a problem-solving tool. This article briefly discusses the steps involved in assisted reproduction. Its aim is to help radiologists become familiarized with the multimodality imaging features of the spectrum of ART-related complications. Their key imaging features and differential considerations are emphasized. This will facilitate the provision of precise and timely diagnoses, and aid the avoidance of fatal consequences.
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22
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Jee J, Hong SJ, Ha S, Kim HY, Ahn KH, Hong SC, Oh MJ, Kim HJ, Cho GJ. Pregnancy outcomes in twin pregnancies over 10 years. Obstet Gynecol Sci 2022; 66:20-5. [PMID: 36444516 DOI: 10.5468/ogs.22232] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/06/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the changes in twin pregnancy outcomes between 2007 and 2016 in a Korean population. METHODS The data for this nationwide population-based study was obtained from the national birth registry of the Korean National Statistical Office and the Health Insurance Review & Assessment Service of Korea. Women with twin pregnancies who gave birth between 2007 and 2016 were included. RESULTS From 2007 to 2016, the rate of twin pregnancies increased (1.37% vs. 1.91%, respectively, P<0.0001). The risk of preterm birth (adjusted odds ratio [aOR], 1.77; 95% confidence interval [CI], 1.66-1.89) also increased; however, the risk of twin growth discordance (aOR, 0.90; 95% CI, 0.82-0.99) decreased. The risks of cesarean section (aOR, 1.16; 95% CI, 1.03-1.29), gestational diabetes mellitus (aOR, 2.10; 95% CI, 1.83-2.39), and postpartum hemorrhage (aOR, 1.27; 95% CI, 1.14-1.41) all increased from 2007 to 2016. CONCLUSION Twin pregnancy outcomes have changed significantly in Korea over a recent 10-year period.
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Sam S, Tai-MacArthur S, Shangaris P, Sankaran S. Trends of Selective Fetal Reduction and Selective Termination in Multiple Pregnancy, in England and Wales: a Cross-Sectional Study. Reprod Sci 2021; 29:1020-1027. [PMID: 34902100 PMCID: PMC8863756 DOI: 10.1007/s43032-021-00819-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/01/2021] [Indexed: 12/01/2022]
Abstract
Selective abortion was shown to be increasingly common in England and Wales over a 9-year period, occurring most frequently as twin to singleton reductions in the 1st trimester. We analysed the trends in selective abortion (SA) in multiple pregnancies in England and Wales between 2009 and 2018. This is a cross-sectional study looking at 1143 women with multiple pregnancies in England and Wales undergoing SA. There were a total of 1143 cases of SA between 2009 and 2018 in England and Wales, representing 0.07% of total abortions. There has been a steady increase in cases, from 90 in 2009 to 131 in 2018, with 82.3% justified under ground E of The Abortion Act 1967. The majority of SAs were carried out at 13–19 weeks gestation, and intracardiac injection of potassium chloride was the most prevalent method (75%). Twin to singleton reductions accounted for 59%, the most common form of SAs. Over half of all cases (59%) were performed in women aged 30–39 years, and 84% of all women were of White ethnicity. SA has been an option available for couples diagnosed with multiple pregnancy, especially when there are discordant anomalies. Although SA may decrease multiple pregnancy-related complications, preventative methods must be championed.
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Affiliation(s)
- Sreya Sam
- GKT School of Biomedical Sciences, Kings College London, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK
| | - Sarah Tai-MacArthur
- School of Bioscience Education, Kings College London, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK
| | - Panicos Shangaris
- Department of Women and Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, 10th Floor North Wing St Thomas' Hospital, London, SE1 7EH, UK. .,Department of Women and Children, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
| | - Srividhya Sankaran
- Department of Women and Children, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
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Stritzel H, Maslowsky J. Higher Rates of Twinning Among Repeat Vs First-Time Teenage and Young Adult Mothers in the United States, 2009-2018. J Pediatr Adolesc Gynecol 2021; 34:739-744. [PMID: 33910087 PMCID: PMC8410677 DOI: 10.1016/j.jpag.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Few studies examining predictors of twinning consider younger mothers who do not use assisted reproductive technologies (ART). Higher parity is associated with greater odds of having a twin birth, but it is unclear whether this association is present among young women. We tested the hypothesis that the rates and odds of twinning would increase with parity among teenage and young adult mothers who did not use ART. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective, population-based cohort study using 2009-2018 United States National Vital Statistics data on 11,383,370 (58.94% first, 41.06% repeat) births to adolescent and adult women aged 15-24 years. INTERVENTIONS None. MAIN OUTCOME MEASURES Rates and odds of twinning by parity among teenage (15-19 years) and young adult (20-24 years) mothers. RESULTS The adjusted twin birth rate among first-time teenage mothers was 13.28 per 1000 births compared to 16.62 twins per 1,000 births among repeat teenage mothers. This difference by parity was present but smaller among mothers aged 20-24 (18.31 vs 21.44 twins per 1000 births for first-time and repeat young adult mothers, respectively). CONCLUSION Repeat young mothers, particularly teenage mothers, are a high-risk group in terms of infant and maternal health outcomes; their higher rate of twinning puts them at an additional risk for adverse birth outcomes. Practitioners may counsel young mothers at risk for subsequent unintended pregnancy on elevated risk of twinning.
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Affiliation(s)
- Haley Stritzel
- Population Research Center, Department of Sociology, The University of Texas at Austin, Austin, Texas
| | - Julie Maslowsky
- Department of Kinesiology and Health Education, Department of Population Health, Population Research Center, The University of Texas at Austin, Austin, Texas.
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Massalska D, Bijok J, Kucińska-Chahwan A, Zimowski JG, Panek G, Roszkowski T. Twin pregnancies discordant for digynic triploidy - A case series. Taiwan J Obstet Gynecol 2021; 60:139-141. [PMID: 33494988 DOI: 10.1016/j.tjog.2020.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To analyse natural course and perinatal management in twin pregnancies discordant for digynic triploidy. CASE REPORT We present five cases of twins discordant for digynic triploidy. Pregnancy outcome was known for three of them. In one case, premature rupture of membranes occurred at 20 gestational weeks and both fetuses were miscarried. In two other pregnancies healthy co-twins were born at term after the triploid fetuses demise at 28 and 37 weeks. No maternal complications were observed. CONCLUSION Twin pregnancies discordant for triploidy poses a challenge for perinatal management. Expectant management should be considered in digynic triploid cases.
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Affiliation(s)
- Diana Massalska
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, Warsaw, Poland.
| | - Julia Bijok
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Kucińska-Chahwan
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Grzegorz Panek
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Tomasz Roszkowski
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, Warsaw, Poland
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Shaw CJ, Paramasivam G, Vacca C, Lees CC. Expectant management versus multifetal pregnancy reduction in dichorionic triamniotic (DCTA) triplets: Single centre experience. Eur J Obstet Gynecol Reprod Biol 2021; 264:200-5. [PMID: 34329945 DOI: 10.1016/j.ejogrb.2021.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES In trichorionic triplet pregnancies, multifetal pregnancy reduction (MFPR) reduces the risk of preterm birth, neonatal morbidity and mortality without increasing miscarriage. A similar benefit has been suggested in dichorionic triamniotic (DCTA) pregnancy, but multiple methods are currently used. This study investigates if the method of reduction used in DCTA triplet pregnancy influences the evidence of benefit from MFPR. METHODS This is a retrospective cohort study of DCTA pregnancies between 2010 and 2019 who attended a single UK fetal medicine tertiary referral center. Cohorts were defined based on MFPR decision and method. The primary outcome was offspring survival until neonatal discharge. The secondary outcomes included miscarriage, preterm birth, livebirth, rates of small for gestational age (SGA) neonates, ans maternal morbidity. To evaluate the differences in neonatal survival until discharge we used Cox proportional regression to calculate hazard rates (HR) and 95% confidence intervals (CI). Differences in secondary outcomes were compared using univariate analysis. RESULTS The study reports the outcomes for 83 DCTA pregnancies. MFPR to DCDA twins was chosen in 19 pregnancies (14 radiofrequency ablation, RFA; 5 intrafetal laser, IFL); in 9 pregnancies selective reduction to a singleton was performed by KCl injection. The rate of pregnancies in with ≥ 1 fetus born alive was not different between groups (p = 0.90). However, the number of expected neonates alive at discharge from hospital was highest in the RFA group (89%, HR 0.28, 95% CI 0.21-0.87, p = 0.02). Rates of premature delivery before 32 weeks (p = 0.02), low birth weight (p < 0.001) and birthweight < 10th percentile (p = 0.01) were all elevated in the expectant management group, compared to women who opted for reduction. There was no difference in miscarriage between groups. CONCLUSIONS Our study suggests that MFPR by RFA, an established and widely available procedure, is of benefit in promoting neonatal survival until discharge in DCTA triplets.
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Esposito G, Somigliana E, Franchi M, Dallagiovanna C, Pisaturo V, Corrao G, Parazzini F. Trend of medically induced monozygotic twin deliveries according to age, parity, and type of assisted reproductive technique during the period 2007-2017 in Lombardy Region, Northern Italy: a population-based study. J Assist Reprod Genet 2021. [PMID: 34244872 DOI: 10.1007/s10815-021-02268-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/24/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The risk of monozygotic (MZT) twinning is increased in pregnancies after assisted reproductive technologies (ART). However, determinants remain poorly understood. To shed more light on this issue, we analyzed the estimated frequency of MZT twins from ART in Lombardy, Northern Italy, during the period 2007–2017. Methods This is a population-based study using regional healthcare databases of Lombardy Region. After having detected the total number of deliveries of sex-concordant and sex-discordant twins from ART, we calculated MZT rate using Weinberg’s method. Standardized ratios (SRs) and corresponding 95% confidence intervals (CI) of MZT deliveries, adjusted for maternal age, were computed according to calendar period, parity, and type of ART. Results On the whole, 19,130 deliveries from ART were identified, of which 3,446 were twins. The estimated rate of MZT births among ART pregnancies was higher but decreased over time (p-value = 0.03); the SRs being 1.33 (95% CI: 1.18–1.51), 0.96 (95% CI: 0.83–1.11), and 0.92 (95% CI: 0.79–1.07) for the periods 2007–2010, 2011–2014, and 2015–2017, respectively. The SRs of MZT among women undergoing first-level techniques, conventional in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) were 0.47 (95% CI: 0.38–0.57), 1.02 (95% CI: 0.88–1.17), and 1.43 (95% CI: 1.27–1.61) (p-value < 0.0001). The ratio of MZT births was significantly higher in women younger than 35 years (p-value < 0.0001) and slightly higher among nulliparae (p-value < 0.0001). Conclusion Despite a reduction of MZT rate from ART over the time, the risk remains higher among ART pregnancies rather than natural ones. Younger women and women undergoing ICSI showed the highest risk of all. Supplementary Information The online version contains supplementary material available at 10.1007/s10815-021-02268-0.
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Tan E, Zhou JC, Mahmood O, Ong CL, Ng CH. MRI signs of intrauterine fetal demise. Abdom Radiol (NY) 2021; 46:3365-3377. [PMID: 33715028 DOI: 10.1007/s00261-021-03031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 11/26/2022]
Abstract
Intrauterine fetal demise (IUFD) is an uncommon but serious event that may occasionally be encountered on fetal MRI. Compared to the more florid signs of fetal demise which has occurred some time ago, recent IUFD is associated with more subtle findings that may be missed or misinterpreted. The two main MRI sequences used in imaging the fetus are T2-like two-dimensional balanced steady-state free-precession (SSFP), a white blood sequence, or T2-weighted single-shot fast spin-echo (SSFSE), a black blood sequence. The most reliable and specific signs of a recent IUFD are a constricted heart with poorly delineated cardiac chambers and signal abnormality in the heart and aorta, which will have different features depending on the MRI sequence used. Secondary signs of IUFD include global brain ischemia, abnormal globes, effusions, body wall edema and umbilical cord thrombosis. Unlike fetal ultrasound examinations where cardiac activity is routinely assessed, fetal MRI requires careful scrutiny of the fetal heart for assessment of fetal life.
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Affiliation(s)
- Eelin Tan
- Department of Diagnostic and Interventional Imaging, KK Womens' and Childrens' Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Joel Cheng'en Zhou
- Department of Diagnostic and Interventional Imaging, KK Womens' and Childrens' Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Omar Mahmood
- Department of Diagnostic and Interventional Imaging, KK Womens' and Childrens' Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Chiou Li Ong
- Department of Diagnostic and Interventional Imaging, KK Womens' and Childrens' Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Chee Hui Ng
- Department of Diagnostic and Interventional Imaging, KK Womens' and Childrens' Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
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Maraj H, Kumari S. No clarity on the definition of parity: A survey accessing interpretation of the word parity amongst obstetricians and midwives and a literature review. Eur J Obstet Gynecol Reprod Biol 2021; 263:15-19. [PMID: 34129962 DOI: 10.1016/j.ejogrb.2021.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We assessed clinical interpretation of the word parity amongst obstetricians and midwives in Wales and performed a literature review to identify a standardised definition. STUDY DESIGN A survey was conducted by electronic questionnaire to obstetricians across Wales and midwives across North Wales. The questionnaire was distributed to obstetricians using the Wales Information System. Midwives were surveyed using a health board wide distribution list. This was followed by a literature review using dictionaries, standard texts, professional bodies and websites. References were obtained for the UK, USA, India, Malaysia and West Indies. RESULTS There were 143 responses from 63 doctors and 80 midwives. 5% of doctors and 49 % of midwives did not include stillbirths after 24 completed weeks in their definition of parity. 84 % of all surveyed described having a previous twin delivery as Para 2. 23 references were obtained for a definition of parity. Parity was variability defined as the number of conceptions, pregnancies, births and babies. Only 12 sources offered a definition in reference to multiple pregnancy. Of these, 8 sources defined multiple births as a single parous event. CONCLUSIONS There are variations in definitions for the term parity from referenced sources and variation in understanding amongst staff surveyed. We recommend UK professional bodies take into consideration the findings of this study and provide a standard consensus definition of parity.
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Affiliation(s)
- Hemant Maraj
- Department of Obstetrics and Gynaecology, Wrexham Maelor Hospital, Wrexham, LL13 7TD, United Kingdom.
| | - Sujatha Kumari
- Department of Obstetrics and Gynaecology, Wrexham Maelor Hospital, Wrexham, LL13 7TD, United Kingdom
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Farquhar C. Avoiding multiple pregnancies in assisted reproductive technologies: transferring one embryo at a time should be the norm. Fertil Steril 2021; 114:671-672. [PMID: 33040978 DOI: 10.1016/j.fertnstert.2020.08.1404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
Multiple pregnancies following fertility treatments typically occur in 30% of women in whom more than one embryo is transferred. Worldwide, fewer than 20 countries have fully funded public fertility treatments, and many women utilizing assisted reproduction technologies are transferring more than one embryo for financial reasons because they consider it will be cheaper to have two embryos transferred in the one procedure. Yet, there is a large body of evidence for the poorer health, economic, and social outcomes for mother and baby from multiple pregnancies. Some countries have reduced the multiple pregnancy rate to less than 5% by linking the funding of ART to policies where the large majority of transfers are single embryos.
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Affiliation(s)
- Cynthia Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Fertility Plus, Auckland District Health Board, Auckland, New Zealand.
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D'Antonio F, Berghella V, Di Mascio D, Saccone G, Sileo F, Flacco ME, Odibo AO, Liberati M, Manzoli L, Khalil A. Role of progesterone, cerclage and pessary in preventing preterm birth in twin pregnancies: A systematic review and network meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 261:166-177. [PMID: 33946019 DOI: 10.1016/j.ejogrb.2021.04.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/10/2021] [Accepted: 04/17/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the role of progesterone, pessary and cervical cerclage in reducing the risk of (preterm birth) PTB in twin pregnancies and compare these interventions using pairwise and network meta-analysis. STUDY DESIGN Medline, Embase, CINAHL and Cochrane databases were explored. The inclusion criteria were studies in which twin pregnancies were randomized to an intervention for the prevention of PTB (any type of progesterone, cervical cerclage, cervical pessary, or any combination of these) or to a control group (e.g. placebo or treatment as usual). Interventions of interest were either progesterone [vaginal or oral natural progesterone or intramuscular 17a-hydroxyprogesterone caproate (17-OHPC)], cerclage (McDonald or Shirodkar), or cervical pessary. The primary outcome was PTB < 34 weeks of gestation. Both primary and secondary outcomes were explored in an unselected population of twin pregnancies and in women at higher risk of PTB (defined as those with cervical length <25 mm). Random-effect head-to-head and a multiple-treatment meta-analyses were used to analyze the data and results expressed as risk ratios. RESULTS 26 studies were included in the meta-analysis. When considering an unselected population of twin pregnancies, vaginal progesterone, intra-muscular17-OHPC or pessary did not reduce the risk of PTB < 34 weeks of gestation (all p > 0.05). When stratifying the analysis for spontaneous PTB, neither pessary, vaginal or intramuscular 17-OHPC were associated with a significant reduction in the risk of PTB compared to controls (all p > 0.05), while there was no study on cerclage which explored this outcome in an unselected population of twin pregnancies. When considering twin pregnancies with short cervical length (≤25 mm), there was no contribution of either pessary, vaginal progesterone, intra-muscular 17-OHPC or cerclage in reducing the risk of overall PTB < 34 weeks of gestation. CONCLUSIONS Cervical pessary, progesterone and cerclage do not show a significant effect in reducing the rate of PTB or perinatal morbidity in twins, either when these interventions are applied to an unselected population of twins or in pregnancies with a short cervix.
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Affiliation(s)
- Francesco D'Antonio
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy.
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Filomena Sileo
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Anthony O Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, United States
| | - Marco Liberati
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | | | - Asma Khalil
- Fetal Medicine Unit, Saint George's University of London, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom
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Farmer N, Hillier M, Kilby MD, Hodgetts-Morton V, Morris RK. Outcomes in intervention and management of multiple pregnancies trials: A systematic review. Eur J Obstet Gynecol Reprod Biol 2021; 261:178-192. [PMID: 33964726 DOI: 10.1016/j.ejogrb.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Twin pregnancy has risks of adverse outcomes for mother and baby. Data synthesis is required to gain evidence to aid recommendations but may be hampered by variations in outcome reporting. STUDY DESIGN Systematically review outcomes reported in twin pregnancy trials (PROSPERO - CRD42019133805). Searches were performed in MEDLINE, EMBASE, CINHAL, Cochrane library (inception-January 2019) for randomised control trials or their follow-up studies reporting prediction, prognosis, intervention or management outcomes in twin pregnancy. The study characteristics, outcomes definitions and measurements were extracted and descriptively analysed. RESULTS 49 RCTs and 8 follow-up studies evaluated 21 interventions, 1257 outcomes, categorised into 170 unique outcomes. 65 % of trials included all twin pregnancies, 12 % DCDA and 11 % MCDA only or MCMA and MCDA. Five (9 %) papers were prediction/ prognosis RCT's and 52 (91 %) related to an intervention. Of interventions, 40 (77 %) were medical, 34 (85 %) for preterm birth; 12 (23 %) surgical, 6 (50 %) related to TTTS interventions (83 % for monochrorionic studies). Commonest domains were: 'Neonatal' 77 %, 'Delivery' 70 % and 'Survival' 67 %. Least reported were longer term outcomes for 'Infant' or 'Parental'. CONCLUSIONS Twin pregnancy outcomes are diverse and complex. This is related to the need to address maternal, single and double fetal outcomes and different types of chorionicity. The lack of outcome standardisation in selection, definition and reporting hinders evidence synthesis and the selection of outcomes important to women and health care professionals thus limiting the effectiveness of research.
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Affiliation(s)
- Nicola Farmer
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's Hospital, Birmingham, UK
| | | | - Mark D Kilby
- Birmingham Women's and Children's Hospital, Birmingham, UK; Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Victoria Hodgetts-Morton
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's Hospital, Birmingham, UK
| | - R Katie Morris
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's Hospital, Birmingham, UK.
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Tang Y, He QD, Zhang TT, Wang JJ, Huang SC, Ye Y. Controlled ovarian stimulation should not be preferred for male infertility treated with intrauterine insemination: a retrospective study. Reprod Biol Endocrinol 2021; 19:45. [PMID: 33740990 PMCID: PMC7977560 DOI: 10.1186/s12958-021-00730-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment. It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Thus, we aimed to investigate efficacy of IUI with COS for isolated male factor infertility. METHODS A total of 601 IUI cycles from 307 couples who sought medical care for isolated male factor infertility between January 2010 and February 2020 were divided into two groups: NC-IUI and COS-IUI. The COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (one follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The IUI outcomes, including clinical pregnancy, live birth, spontaneous abortion, ectopic pregnancy, and multiple pregnancy rates were compared. RESULTS The clinical pregnancy, live birth, spontaneous abortion, and ectopic pregnancy rates were comparable between the NC-IUI and COS-IUI group. Similar results were also observed among the NC-IUI, one follicle, and ≥ 2 follicles groups. However, with respect to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared to the NC-IUI group (8.7% vs. 0, P = 0.091), and a significant difference was found between the NC-IUI and ≥ 2 follicles group (0 vs. 16.7%, P = 0.033). CONCLUSION In COS cycles, especially in those with at least two pre-ovulatory follicles, the multiple pregnancy rate increased without a substantial gain in overall pregnancy rate; thus, COS should not be preferred in IUI for isolated male factor infertility. If COS is required, one stimulated follicle and one healthy baby should be the goal considering the safety of both mothers and foetuses.
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Affiliation(s)
- Yan Tang
- Department of Gynecology and Obstetrics, Centre for Reproductive Medicine, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Shiqi District, Zhongshan, 528400, Guangdong Province, China
| | - Qian-Dong He
- Department of Gynecology and Obstetrics, Centre for Reproductive Medicine, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Shiqi District, Zhongshan, 528400, Guangdong Province, China
| | - Ting-Ting Zhang
- Department of Gynecology and Obstetrics, Centre for Reproductive Medicine, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Shiqi District, Zhongshan, 528400, Guangdong Province, China
| | - Jing-Jing Wang
- Department of Gynecology and Obstetrics, Centre for Reproductive Medicine, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Shiqi District, Zhongshan, 528400, Guangdong Province, China
| | - Si-Chong Huang
- Department of Gynecology and Obstetrics, Centre for Reproductive Medicine, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Shiqi District, Zhongshan, 528400, Guangdong Province, China
| | - Yun Ye
- Department of Gynecology and Obstetrics, Centre for Reproductive Medicine, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Shiqi District, Zhongshan, 528400, Guangdong Province, China.
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Kahraman S, Duzguner INB, Duzguner S, Sahin Y, Sen C. Incidence of multiple births in relation to current regulations in Turkey regarding embryo transfer. BMC Pregnancy Childbirth 2021; 21:117. [PMID: 33563225 DOI: 10.1186/s12884-021-03616-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 02/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background Before 2010, there were no regulations in Turkey regarding the number of embryos to be transferred in one cycle. In March 2010, regulations restricting this number were implemented by the Turkish Ministry of Health. These specify the transfer of a maximum of one embryo in the first and second cycles and a maximum of two embryos in subsequent cycles in women aged < 35, and a maximum of two embryos in women aged ≥35 in any one cycle. Our study evaluates the effect of these regulations. Methods This large retrospective single center study first evaluates the incidence of multiple pregnancies before and after the implementation of the 2010 regulations. Secondly, it compares the clinical outcomes of double blastocyst transfer (DBT) and single blastocyst transfer (SBT) performed in compliance with these regulations from 2014 onwards. Results After the introduction of the 2010 regulations, the multiple pregnancy rate decreased significantly from 37.9 to 15.7%. The singleton live birth rate increased significantly, whereas multıiple live birth rates significantly decreased (p = < 0.001). When the clinical outcomes of SBT and DBT performed in compliance with regulations from 2014 onwards were evaluated, in patients < 35 years, the multiple pregnancy rate decreased from 47.2% in the DBT group to 1.7% in the SBT group (p = < 0.001). In patients ≥35 years, in the DBT group, the twin birth rate was again high at 28.4%, whereas in the SBT group, it was only 1.8% (p = < 0.001). Importantly, there was no statistically significant difference in clinical pregnancy rates between these two groups. Conclusion Turkish regulations have led to an encouragement of double embryo transfer (DET) as a routine practice, with many patients understanding it as an absolute right to have two embryos transferred. The results of our study suggest that, especially in the light of the success of blastocyst transfer, the Turkish regulations should be amended to limit the use of DET and encourage the use of single embryo transfer except in exceptional cases and particularly in women under 35 years old.
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Adamson GD, Norman RJ. Why are multiple pregnancy rates and single embryo transfer rates so different globally, and what do we do about it? Fertil Steril 2020; 114:680-689. [PMID: 33010940 DOI: 10.1016/j.fertnstert.2020.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
In the early years of in vitro fertilization, overall pregnancy rates were low, and it was considered necessary to transfer more than one embryo to increase the chances of pregnancy. It was not until advances in assisted reproductive technologies resulting in increased pregnancy rates that the concept of transferring just one embryo was considered possible. A consequence of improvements in implantation rates was also an increase in multiple pregnancies when more than one embryo was transferred. Although some countries have reduced the number of embryos transferred, international data show that in many parts of the world high twin and higher order multiple pregnancy rates still exist. Even in developed countries these problems persist depending on clinical practice, funding of health services, and patient demands. Perinatal and other outcomes are significantly worse with twins compared with singleton pregnancies and there is an urgent need to reduce multiple pregnancy rates to at least 10%. This has been achieved in several countries and clinics by introducing single embryo transfer but there are many barriers to the introduction of this technique in most clinics worldwide. We discuss the background to the high multiple rate in assisted reproduction and the factors that contribute to its persistence even in excellent clinics and in high-quality health services. Practices that may promote single embryo transfer are discussed.
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Affiliation(s)
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
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Hassani ME, Drissi J, Benali S, Habib AB, Kouach J, Moussaoui D. [Delayed delivery in multiple pregnancy: about a case and literature review]. Pan Afr Med J 2020; 36:373. [PMID: 33235650 PMCID: PMC7666699 DOI: 10.11604/pamj.2020.36.373.19797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/02/2020] [Indexed: 11/11/2022] Open
Abstract
Delayed delivery is designed to allow the remaining fetus(es) to develop after premature expulsion of the first twin in the second trimester of pregnancy. This decision is aimed to allow the remaining fetus(es) to reach full fetal growth. We here report a clinical case of delayed delivery in a patient with triple pregnancy in whom the time between the expulsion of the first twin and the birth of the third twin was 10 weeks. The purpose of this study was to highlight the benefit and indications for delayed delivery.
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Affiliation(s)
- Mehdi El Hassani
- Service de Gynécologie-Obstétrique, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
| | - Jihad Drissi
- Service de Gynécologie-Obstétrique, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
| | - Saad Benali
- Service de Gynécologie-Obstétrique, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
| | - Abdellah Baba Habib
- Service de Gynécologie-Obstétrique, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
| | - Jaouad Kouach
- Service de Gynécologie-Obstétrique, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
| | - Driss Moussaoui
- Service de Gynécologie-Obstétrique, Hôpital Militaire d´Instruction Mohamed V, Rabat, Maroc
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Gent J, Nanda S, Khalil A, Sharp A. Antenatal management of multiple pregnancies within the UK: A survey of practice. Eur J Obstet Gynecol Reprod Biol 2020; 254:74-78. [PMID: 32942079 DOI: 10.1016/j.ejogrb.2020.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/12/2020] [Accepted: 08/21/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To identify variation in the antenatal management of multiple pregnancy. The UK has 10,000 twin pregnancies per year. There is established guidance on the management of dichorionic (DC) and monochorionic (MC) twin pregnancy from both the RCOG and NICE, however it is likely that the provision and practice of multiple pregnancy management varies amongst units. DESIGN Questionnaires were posted to 151 UK maternity units in 3 rounds from May to November 2019. RESULTS 60 responses were received (range 11,500 to 501 deliveries), with annual multiple pregnancy rates of 190 to 4. 25 % of units did not offer a dedicated twin clinic and less than 15 % of units provided dedicated multiple pregnancy midwifery staff for intrapartum and postnatal care. Cervical length screening was performed in 24 % of units with 84 % of units offering treatment for a short cervix. 15 % of units prescribed Aspirin to all multiples, 47 % prescribing 75 mg and 43 % 150 mg. Monitoring of MC pregnancies varied with 18 % of units not measuring Middle Cerebral Artery and 29 % Ductus Venosus Dopplers. Mean caesarean section rate was 61.7 %. Delivery was offered from 37 weeks in 93 % of DC twins and from 36 weeks in 90 % MC twins. 5% of MC twins were given non labouring prophylactic antenatal steroids. CONCLUSION Despite well-established national guidance for twin pregnancy management there remains a wide variation in practice among units in the provision and antenatal management of multiple pregnancies throughout the UK. The exact reasons for this variation require further exploration.
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Affiliation(s)
- Joanna Gent
- Harris-Wellbeing Research Centre, Liverpool Women's Hospital, University of Liverpool, UK
| | - Surabhi Nanda
- Fetal Medicine Unit, Guy's and St Thomas's Hospital, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, University of London, London, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, UK
| | - Andrew Sharp
- Harris-Wellbeing Research Centre, Liverpool Women's Hospital, University of Liverpool, UK.
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Sebghati M, Khalil A. Reduction of multiple pregnancy: Counselling and techniques. Best Pract Res Clin Obstet Gynaecol 2020; 70:112-122. [PMID: 32859535 DOI: 10.1016/j.bpobgyn.2020.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/16/2020] [Indexed: 12/01/2022]
Abstract
The incidence of multiple births has risen in the last few decades. This rise is mainly due to the widespread use of assisted reproduction techniques mainly as a result of increasing maternal age at conception. Twin and higher-order multiple pregnancies are associated with increased risk of perinatal, as well as maternal, mortality and morbidity compared to singleton pregnancies. There can also be psychosocial and socioeconomic implications for women and their families. In this chapter, we aim to discuss the risks associated with multiple pregnancies, the pros and cons of fetal reduction, the current techniques used in clinical practice, and how to approach counselling parents, enabling them to make informed decisions.
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Affiliation(s)
- Mercede Sebghati
- Fetal Medicine Unit, St George's University Hospitals, Blackshaw Road, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals, Blackshaw Road, London, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, UK; Twins Trust Centre for Research and Clinical Excellence, UK.
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Schivardi G, Angileri SA, Esposito G, Di Meglio L, Brusati V, Ierardi AM, Carrafiello G, Marconi AM. Successful Transvaginal Microwave Ablation of a Heterotopic Cervical Pregnancy. A Case Report. Reprod Sci 2020; 28:27-30. [PMID: 32729020 PMCID: PMC7782446 DOI: 10.1007/s43032-020-00270-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/22/2020] [Indexed: 01/17/2023]
Abstract
Heterotopic cervical pregnancy is a rare and potentially dangerous condition where the challenge is the removal of the ectopic pregnancy while preserving the intrauterine one. We present the case of an otherwise healthy 36-year-old woman with heterotopic cervical pregnancy after an IVF cycle for tubal infertility. At 6.5 weeks after a consultation with gynecologists and interventional radiologists, the patient agreed to undergo microwave ablation of the cervical pregnancy. Monthly ultrasound examination showed the persistence of non homogeneous and vascularized tissue in the cervix. Intrauterine pregnancy continued without complications until 37 weeks when a cesarean section was performed for sudden and profuse bleeding, in the presence of uterine contractions. A healthy baby girl was delivered, and the postoperative course was otherwise uncomplicated. Heterotopic cervical pregnancies are rare, and no consolidated and risk-free treatments are available at the moment. Here, we present a case of heterotopic cervical pregnancy treated successfully and without complications with microwave ablation.
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Affiliation(s)
- Gabriella Schivardi
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Salvatore Alessio Angileri
- Department of Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy
| | - Giampiero Esposito
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Letizia Di Meglio
- Department of Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy
| | - Valentina Brusati
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Anna Maria Ierardi
- Department of Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy.,Department of Health Sciences, University of Milano, Via A di Rudinì 8, 20142, Milan, Italy
| | - Anna Maria Marconi
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy. .,Department of Health Sciences, University of Milano, Via A di Rudinì 8, 20142, Milan, Italy.
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Alkan H, Kivrak MB, Satilmis F, Tekindal MA, Dinc DA. Detection of twin pregnancies in ewes by pregnancy-associated glycoprotein assay and transabdominal ultrasonography. Domest Anim Endocrinol 2020; 72:106399. [PMID: 32380310 DOI: 10.1016/j.domaniend.2019.106399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/23/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
The objectives of the present study were to evaluate and compare the accuracy of transabdominal ultrasonography and pregnancy-associated glycoprotein (PAG) assay in the diagnosis of twin pregnancies in ewes and to evaluate the utility of the PAG assay for predicting fetal gender in singleton pregnancies. The animals in the study consisted of 179 pregnant ewes. The number of fetuses in the ewe was determined using transabdominal ultrasonography between days 40 and 60 (on days 40, 45, 50, 55, and 60). Blood samples were collected from all the ewes on the same day to determine the PAG concentrations. The results found were highly sensitive for the detection of twin pregnancies by transabdominal ultrasonography. The accuracy of transabdominal ultrasonography in detecting twin pregnancies was found to be higher on day 60 than on other days (P < 0.05). The sensitivities of PAG assay in detecting twin pregnancies on days 40, 45, 50, 55, and 60 were 91.67%, 66.67%, 81.82%, 88.89%, and 33.33%, respectively. The accuracies of the PAG assay in detecting twin pregnancies on days 40, 45, and 50 were found to be statistically significant higher than other days (P < 0.05). The PAG assay had low sensitivity and specificity for predicting fetal gender. It was concluded that twin pregnancies in ewes can be diagnosed with high accuracy using transabdominal ultrasonography on day 60 of pregnancy and as well as using the PAG assay during the early days of pregnancy (on days 40, 45, and 50). The PAG assay is not useful for predicting fetal gender.
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Affiliation(s)
- H Alkan
- Faculty of Veterinary Medicine, Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey.
| | - M B Kivrak
- Faculty of Veterinary Medicine, Department of Obstetrics and Gynecology, Cumhuriyet University, Sivas, Turkey
| | - F Satilmis
- Faculty of Veterinary Medicine, Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey
| | - M A Tekindal
- Faculty of Veterinary Medicine, Department of Biostatistics, Selcuk University, Konya, Turkey
| | - D A Dinc
- Faculty of Veterinary Medicine, Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey
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Verhaeghe C, Abnoun S, May-Panloup P, Corroenne R, Legendre G, Descamps P, El Hachem H, Bouet PE. Conversion of in vitro fertilization cycles to intrauterine inseminations in patients with a poor ovarian response: Risk of multiple pregnancies. J Gynecol Obstet Hum Reprod 2020; 49:101831. [PMID: 32535238 DOI: 10.1016/j.jogoh.2020.101831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the risk of multiple pregnancies (MP) following conversion of in vitro fertilization (IVF) cycles to intrauterine insemination (IUI) when a poor ovarian response (POR) is diagnosed during controlled ovarian stimulation (COS). METHODS We undertook a retrospective study in our teaching hospital from January 2012 to December 2017. We included all IVF cycles with POR that were converted to IUI (<5 follicles ≥ 14 mm and peak estradiol level < 1000 pg/mL on trigger day). RESULTS Overall, 205 IVF cycles that were converted to IUI in 128 patients were analyzed. Mean age was 34.1 ± 4.6 years, mean antral follicle count was 11 ± 5.3 and mean AMH was 1.8 ± 2.9 ng/L. The main causes of infertility were unexplained (41 %) (84/205) and diminished ovarian reserve (35 %) (72/205). Of all the cycles converted to IUI, 53 (26 %) had one mature follicle on trigger day, 56 (27 %) had 2, 56 (27 %) had 3, and 40 (20 %) had 4. The live birth rate (LBR) was 7.3 % (15/205), and the miscarriage rate was 28.6 % (6/21). There were 3 twin pregnancies, but no higher order pregnancies; the MP rate was 14.3 % (3/21). There was no significant difference in the MP rate between patients with 1-2 mature follicles and patients with 3-4 mature follicles (18.2 % vs 10 %, p = 0.99, respectively). CONCLUSION In IVF cycles converted to IUI for poor response, the risk of MP is acceptable (14 %) with no higher order pregnancies, even with 3 or 4 follicles ≥14 mm on trigger day.
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Affiliation(s)
- Caroline Verhaeghe
- Department of Reproductive Medicine, Angers University Hospital, Angers, France
| | - Sarah Abnoun
- Department of Reproductive Medicine, Angers University Hospital, Angers, France
| | - Pascale May-Panloup
- Department of Reproductive Medicine, Angers University Hospital, Angers, France
| | - Romain Corroenne
- Department of Reproductive Medicine, Angers University Hospital, Angers, France
| | - Guillaume Legendre
- Department of Reproductive Medicine, Angers University Hospital, Angers, France
| | - Philippe Descamps
- Department of Reproductive Medicine, Angers University Hospital, Angers, France
| | - Hady El Hachem
- Department of Reproductive Medicine, Clemenceau Medical Center, Beirut, Lebanon
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Marleen S, Dias C, MacGregor R, Allotey J, Aquilina J, Khalil A, Thangaratinam S. Biochemical predictors of preterm birth in twin pregnancies: A systematic review involving 6077 twin pregnancies. Eur J Obstet Gynecol Reprod Biol 2020; 250:130-142. [PMID: 32446146 DOI: 10.1016/j.ejogrb.2020.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
In women with twin pregnancies biomarkers are not used to predict preterm birth in clinical practice. This systematic review assessed the risk of both spontaneous and iatrogenic preterm birth in twin pregnancies based on biochemical predictors. We searched the electronic databases from January 1990 to June 2019 without language restrictions. All studies on twin pregnancies where biochemical predictors and preterm birth were evaluated were included. We reported our findings as odds ratio (OR) with 95 % confidence intervals (CI) and pooled the estimates using random-effects meta-analysis for various predictor thresholds. From 12,623 citations, we included 33 studies involving 6077 pregnancies. The odds of preterm birth <28 weeks (OR 12.06, 95 % CI 4.90-29.70, I2 = 0%), <32 weeks (OR 10.03, 95 % CI 6.11-16.47, I2 = 0%), <34 weeks (OR 6.26, 95 % CI 3.85-10.17, I2 = 30 %), <37 weeks (OR 5.34, 95 % CI 3.68-7.76, I2 = 15 %) and delivery within 14 days of testing (OR 13.95, 95 % CI 4.33-44.98, I2 = 0%) was increased among women with a positive fetal Fibronectin (fFN) test who were either symptomatic or asymptomatic for preterm birth. Similarly, higher odds of preterm birth was also seen among twin pregnancies asymptomatic for preterm birth with a positive fFN test at gestations <32 weeks (OR 10.54, 95 % CI 5.66-19.64, I2 = 19 %), < 34 weeks (OR 8.07, 95 % CI 5.28-12.33, I2 = 0%) and < 37 weeks (OR 6.21, 95 % CI 4.34-8.87, I2 = 0%). As for other biomarkers, a significantly higher odds of preterm birth <37 weeks was seen among women with elevated maternal serum human Chorionic Gonadotrophin (mshCG) (OR 1.51, 95 % CI 1.07-2.13, I2 = 0%), 25 Hydroxy Vitamin D level <75 nmol/l (OR 2.59, 95 % CI 1.35-4.95, I2=NA), positive phosphorylated Insulin-like Growth Factor Binding Protein-1 (phIGFBP-1) (OR 4.23, 95 % CI 1.97-9.09, I2 = 0%) and in those with elevated Interleukin 8 (IL-8) (OR 3.13, 95 % CI 1.18-8.34, I2=NA). A higher odds of preterm birth at <34 weeks gestation was seen among women with maternal serum Alpha fetoprotein (AFP)>3.5 MoM (OR 2.35, 95 % CI 1.12-4.96, I2=NA) while higher odds of preterm birth at <32 weeks was seen among women with 25 Hydroxy Vitamin D level <75 nmol/l (OR 3.01, 95 % CI 1.26-7.19, I2=NA). Delivery within seven days of testing was significantly increased in women with a positive Matrix Metallo Protein-8 (MMP-8) test (OR 10.59, 95 % CI 3.70-30.29, I2=NA). Fetal Fibronectin is strongly associated with predicting preterm birth among women with twin pregnancies who are either asymptomatic or symptomatic for preterm birth as well as in those asymptomatic for preterm birth. Other biomarkers have shown a positive association in the prediction of preterm birth among women with twin pregnancies. Further studies are recommended to evaluate their role.
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Affiliation(s)
- Shemoon Marleen
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; World Health Organization (WHO) Collaborating Centre for Women's Health, Queen Mary University of London, London, UK.
| | | | | | - John Allotey
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; World Health Organization (WHO) Collaborating Centre for Women's Health, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub (mEsh), Queen Mary University of London, London, UK
| | | | - Asma Khalil
- St George's University Hospitals NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's Medical School, University of London, UK
| | - Shakila Thangaratinam
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; World Health Organization (WHO) Collaborating Centre for Women's Health, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub (mEsh), Queen Mary University of London, London, UK
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Radhakrishnan P, Thakar S, Chauhan S, Acharya V, Shettikeri A. Combination of "Markers" and the Consequent Importance of Fetal Abdominal Circumference in the First Trimester for Predicting Complications Specific to Monochorionic Twin Pregnancies. Fetal Diagn Ther 2020; 47:580-586. [PMID: 32344423 DOI: 10.1159/000505812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multifetal pregnancies are considered high-risk pregnancies compared to singleton pregnancies. Monochorionic diamniotic (MCDA) twin pregnancies tend to have a more complicated intrauterine course than their dichorionic counterparts. The most common complications are twin-to-twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), and unexplained intrauterine fetal demise (IUFD). Early recognition of pregnancies at risk of developing complications will be helpful for counselling the parents and preparing them for necessary interventions in case a complication arises. OBJECTIVES The aim of our study was to assess the role of discordant crown-rump length (dCRL), discordant nuchal translucency (dNT), and discordant abdominal circumference (dAC) measurements in isolation and in combination at the 11-13+6 weeks' scan in predicting the development of TTTS, sFGR, and IUFD. METHODS All MCDA twin pregnancies with structurally normal, both live fetuses at the 11-13+6 weeks' scan were followed up by FMF (Fetal Medicine Foundation)-certified operators for development of TTTS, sFGR, and single/double IUFD until delivery. Discordance of CRL, NT, and AC of more than or equal to 10% was considered a "marker," and its presence was correlated with the occurrence of specific antenatal complications, i.e., TTTS, sFGR, and single or double IUFD. RESULTS Combination of two markers predicted MCDA-related complications in the majority of cases (70.8% positive predictive value). Combination of dNT and dAC was the strongest predictor (80% positive predictive value). CONCLUSIONS In our population of MC twin pregnancies, dCRL, dNT, and dAC at the 11+0-13+6 weeks' scan, in isolation, had a low predictive value for antenatal complications, i.e., TTTS, sFGR, and single/double IUFD. However, the presence of at least two markers in the first trimester could predict complications in the majority of these pregnancies. The combination of dNT and dAC appears to be the best.
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Affiliation(s)
| | - Saket Thakar
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
| | - Satyajit Chauhan
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
| | - Veena Acharya
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
| | - Anitha Shettikeri
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
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Hui D, Han X, Wang X, Ren W, Lei X, Liu J, Dong L, Li H. Morula transfer achieves better clinical outcomes than post-thawed cleavage embryos after overnight culture in frozen embryo transfer (FET) cycles. J Assist Reprod Genet 2020; 37:945-52. [PMID: 32072380 DOI: 10.1007/s10815-020-01708-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/30/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This study aimed to investigate the clinical outcomes of morula stage transfer derived from post-thawed cleavage embryos undergoing overnight culture in frozen embryo transfer (FET) cycles. METHODS We performed a retrospective study that included 392 FET cycles with 784 thawed embryos undergoing overnight culture between January 2014 and December 2018. Embryos were divided into three groups in terms of their status: 8-16 cells without morula (group I), one morula (group II), and two morulae (group III). The clinical outcomes of these cycles were then compared between the three groups. Logistic regression analysis was performed to control for confounders. RESULTS Group III was associated with a significantly higher clinical pregnancy rate (odds ratio [OR] 2.35; 95% confidence interval [CI] 1.29-4.27; P = 0.005), implantation rate (OR 3.00; CI 1.75-5.16; P < 0.001), multiple pregnancy rate (OR 4.91; CI 2.11-11.40; P < 0.001), and live birth rate (OR 1.96; CI 1.10-3.49; P = 0.022) than group I. Group II had a higher live birth rate than group I after adjustment (OR 1.70; CI 1.04-2.79; P = 0.035). There was no difference in the rate of premature delivery when compared across the three groups after adjustment. CONCLUSION The transfer of morula stage embryos following the overnight culture of post-thawed cleavage embryos led to an improvement in the clinical outcomes of FET cycles. It is important to reduce the number of morula embryos transferred in order to achieve a singleton pregnancy.
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Aziz M, Arronte J. A case of spontaneous heterotopic pregnancy in natural conception complicated with hemoperitoneum. Heliyon 2020; 6:e03373. [PMID: 32072059 PMCID: PMC7013160 DOI: 10.1016/j.heliyon.2020.e03373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/25/2019] [Accepted: 02/02/2020] [Indexed: 11/25/2022] Open
Abstract
Heterotopic pregnancy, defined as simultaneous intrauterine and ectopic gestations, is an uncommon occurrence in women who conceive without assisted reproduction techniques. We present the case of 28 years old female with strong family history of multiple gestations, who presented with acute severe abdominal pain and diagnosed with spontaneous heterotopic pregnancy in natural conception. Ectopic pregnancy was successfully removed surgically to conserve the uterine pregnancy. After one week, patient presented with vaginal bleeding and diagnosed with missed abortion and lost her desired uterine pregnancy. This case report discusses the significance of early diagnosis and treatment of heterotopic pregnancy to avoid both fetal and maternal morbidity and mortality. Practitioners should carry a high index of suspicion for heterotopic pregnancy in patients presenting with common symptoms and carry a family history of multiple gestation pregnancies.
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Affiliation(s)
- Muhammad Aziz
- Family Medicine Center, West Kendall Baptist Hospital, Baptist Health South Florida, Miami, FL, USA.,Florida International University, Department of Humanities, Health, and Society (HHS), Herbert Wertheim College of Medicine, Miami, FL, USA.,Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL, USA
| | - Julio Arronte
- Family Medicine Center, West Kendall Baptist Hospital, Baptist Health South Florida, Miami, FL, USA.,West Kendall OBGYN, West Kendall Baptist Hospital, Miami, FL, USA
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Abgral M, Victoire Senat M, Houllier M, Bouchghoul H. [How I do… a selective feticide using ultrasound-guided bipolar cord coagulation in a monochorionic pregnancy?]. ACTA ACUST UNITED AC 2020; 48:520-523. [PMID: 31923644 DOI: 10.1016/j.gofs.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- M Abgral
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - M Victoire Senat
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris-Saclay, université Paris-Sud, UVSQ, CESP, Inserm, 94807 Villejuif, France
| | - M Houllier
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - H Bouchghoul
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris-Saclay, université Paris-Sud, UVSQ, CESP, Inserm, 94807 Villejuif, France.
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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: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Lipi LB, Philp L, Goodman AK. A challenging case of twin pregnancy with complete hydatidiform mole and co-existing normal live fetus - A case report and review of the literature. Gynecol Oncol Rep 2019; 31:100519. [PMID: 31890831 PMCID: PMC6926326 DOI: 10.1016/j.gore.2019.100519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/12/2019] [Indexed: 12/03/2022] Open
Abstract
Twin pregnancy with complete hydatidiform mole and co-existing normal live fetus is rare. Antenatal and postpartum complications such as gestational trophoblastic neoplasia are common. Patients require close clinical monitoring and urgent delivery in the setting of complications. Follow-up with serum β-HCG is important for the diagnosis of persistent trophoblastic disease.
Hydatidiform mole coexisting with a normal live fetus in a twin pregnancy is extremely rare. Management of these cases is challenging due to the risk of severe antepartum and post-partum complications. Herein, we report the case of a 24-year-old gravida 2 para 1 who presented at 28 weeks gestation with severe preeclampsia, vulvar edema and a serum β-HCG of 285,000 IU/mL. Ultrasonography demonstrated a single live intra-uterine pregnancy with concurrent hydatidiform mole. Conservative management with magnesium sulfate and anti-hypertensive medications was initiated however the patient developed HELLP syndrome and required urgent delivery at 33 weeks. Copious molar tissue was removed from the uterus during delivery. Four weeks post-partum, her β-HCG had dropped to 14,000 IU/ml and continued to decline at 6 weeks (2900 IU/ml). However, at eight weeks, it increased to 3500 IU/ml and the patient was treated with nine cycles of intramuscular methotrexate. Current guidelines for management of a twin pregnancy with coexistent mole recommend close clinical monitoring if the mother and fetus are stable and urgent delivery in the setting of complications. During the postpartum period, careful follow up with clinical evaluation and serial serum β-HCG is important for the diagnosis and treatment of persistent trophoblastic disease.
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Affiliation(s)
- L B Lipi
- Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - L Philp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - A K Goodman
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, United States
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Yamashita S, Ikemoto Y, Ochiai A, Yamada S, Kato K, Ohno M, Segawa T, Nakaoka Y, Toya M, Kawachiya S, Sato Y, Takahashi T, Takeuchi S, Nomiyama M, Tabata C, Fujiwara T, Okamoto S, Kawamura T, Kawagoe J, Yamada M, Sato Y, Marumo G, Sugiyama R, Kuroda K. Analysis of 122 triplet and one quadruplet pregnancies after single embryo transfer in Japan. Reprod Biomed Online 2019; 40:374-380. [PMID: 32033910 DOI: 10.1016/j.rbmo.2019.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/11/2019] [Accepted: 11/21/2019] [Indexed: 11/24/2022]
Abstract
RESEARCH QUESTION What is the prevalence of triplet and quadruplet pregnancies after single embryo transfer (SET) in Japan. DESIGN A retrospective observational study was conducted on 274,605 pregnancies after 937,848 SET cycles in registered assisted reproductive technology (ART) data from the Japanese ART national registry database between 2007 and 2014. A questionnaire survey of ART centres was also conducted. Data on pregnancies with embryo division into three or more after SET were analysed. RESULTS According to the Japanese ART national registry database, SET resulted in 109 triplet pregnancies (0.04% of pregnancies), and the questionnaire reports from 31 centres revealed 33 triplet and one quadruplet pregnancies. After exclusion of 20 duplicated cases, 122 triplet and one quadruplet pregnancies included 46 monochorionic (one gestational sac [37.4%]), 18 dichorionic (two gestational sacs [14.6%]) and 59 trichorionic pregnancies (three gestational sacs [48.0%]). Compared with singleton pregnancies, patients with monozygotic triplet or quadruplet pregnancies were less frequently diagnosed with unexplained infertility (P = 0.004), more often received gonadotrophin injections for ovarian stimulation in 39 cases with information available (P = 0.021) and underwent more blastocyst transfers and assisted hatching (P = 0.002 and P < 0.001, respectively). The proportion of live birth, defined as at least one baby born, excluding induced abortion, was 64.6% (73/116 pregnancies) of monozygotic triplet or quadruplet pregnancies. CONCLUSIONS Combined Japanese ART national registry and survey data revealed 122 triplet and one quadruplet pregnancies, the majority after cryopreserved embryo transfer. Most were conceived after blastocyst transfer and often after assisted hatching, which are potential risk factors for zygotic splitting.
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Affiliation(s)
- Satoko Yamashita
- Juntendo University Faculty of Medicine, Department of Obstetrics and Gynecology, Tokyo 113-8421, Japan; Oita University, Faculty of Medicine, Department of Obstetrics and Gynecology, Oita 879-5593, Japan
| | - Yuko Ikemoto
- Juntendo University Faculty of Medicine, Department of Obstetrics and Gynecology, Tokyo 113-8421, Japan
| | - Asako Ochiai
- Juntendo University Faculty of Medicine, Department of Obstetrics and Gynecology, Tokyo 113-8421, Japan
| | | | | | - Motoharu Ohno
- Juntendo University Faculty of Medicine, Department of Obstetrics and Gynecology, Tokyo 113-8421, Japan; Saint Mother Obstetrics and Gynecology Clinic, Institute for ART, Fukuoka 807-0825, Japan
| | | | | | | | | | | | - Toshifumi Takahashi
- Fukushima Medical University, Fukushima Medical Center for Children and Women, Fukushima 960-1295, Japan
| | - Shigeto Takeuchi
- ART Reproductive Medical Center, Saiseikai Matsusaka General Hospital, Mie 515-8557, Japan
| | - Mari Nomiyama
- Takagi Hospital, Department of Obstetrics and Gynecology, Fukuoka 831-0016, Japan
| | - Chisa Tabata
- Sanno Hospital, Center for Human Reproduction and Gynecologic Endoscopy, Tokyo 107-0052, Japan
| | - Toshihiro Fujiwara
- Sanno Hospital, Center for Human Reproduction and Gynecologic Endoscopy, Tokyo 107-0052, Japan; Phoenix ART Clinic, Tokyo 151-0051, Japan
| | | | | | - Jun Kawagoe
- Yamagata University Faculty of Medicine, Department of Obstetrics and Gynecology, Yamagata 990-9585, Japan
| | - Mitsutoshi Yamada
- Keio University School of Medicine, Department of Obstetrics and Gynecology, Tokyo 160-8582, Japan
| | - Yuichi Sato
- Tatedebari Sato Hospital, Obstetrics & Gynecology, Gunma 370-0836, Japan
| | - Genzo Marumo
- Marumo Ladies Clinic, Department of Obstetrics and Gynecology, Tokyo 106-6004, Japan
| | - Rikikazu Sugiyama
- Sugiyama Clinic Shinjuku, Center for Reproductive Medicine and Implantation Research, Tokyo 116-0023, Japan
| | - Keiji Kuroda
- Juntendo University Faculty of Medicine, Department of Obstetrics and Gynecology, Tokyo 113-8421, Japan; Sugiyama Clinic Shinjuku, Center for Reproductive Medicine and Implantation Research, Tokyo 116-0023, Japan.
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Shettikeri A, Acharya V, V S, Sahana R, Radhakrishnan P. Outcome of Pregnancies Diagnosed with TRAP Sequence Prenatally: A Single-Centre Experience. Fetal Diagn Ther 2019; 47:301-306. [PMID: 31770756 DOI: 10.1159/000503389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/15/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Twin reversed arterial perfusion (TRAP) sequence is a phenomenon seen in 1-3% of monochorionic twin pregnancies, where the acardiac fetus is found to have multiple anomalies. The normal pump twin maintains its own perfusion in addition to that of its acardiac co-twin. As a result, if the acardiac twin increases in size, the burden on the pump twin is increased, leading to cardiac failure, hydrops fetalis, polyhydramnios, premature delivery, and perinatal death. The outcome of pregnancy is largely dependent on the growth of the acardiac twin. In view of high perinatal loss, surgical techniques to interrupt the blood flow to the acardiac twin have been evaluated. METHODS We evaluated interstitial laser therapy, which is the main mode of therapy in our unit, of TRAP pregnancies referred over a 5-year period. Interstitial laser was offered if the blood flow in the acardiac twin was found to be persistent at 2 consecutive examinations or if there were cardiac or hydropic changes in the pump twin at the first examination. RESULTS A total of 18 cases of TRAP were referred during this period and all were counselled regarding fetal therapy if the situation were to deteriorate; 5 couples (27.7%) opted for termination of pregnancy; of the remaining 13, 7 (53.8%) agreed to perform intervention following confirmation of a normal karyotype. Six (85.7%) and 1 (14.3%) lasers were performed in the second and third trimesters, respectively; all 7 had a normal outcome of the pump twin. There were 6/13 (46.2%) in the expectant group who continued the pregnancy with no intervention, with 2 term live births (33.3%). CONCLUSIONS Our study confirms that there is a high risk of spontaneous loss in untreated pregnancies with TRAP, primarily due to polyhydramnios and fetal hydrops. In the pregnancies that underwent interstitial laser, there was a more favourable outcome. Interstitial laser is minimally invasive, safe, and feasible in experienced hands.
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Affiliation(s)
- Anitha Shettikeri
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
| | - Veena Acharya
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
| | - Shailaja V
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
| | - Reeth Sahana
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
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