RESUMEN
BACKGROUND: Preterm birth is a significant obstetrical concern around the globe. With this study, we aimed to determine whether a prior singleton pregnancy preterm birth increases the likelihood of preterm birth in subsequent twin pregnancies. We designed his systematic review to provide valuable information for pregnant women and obstetricians during counselling and for individuals involved in the planning of preventive strategies. METHODS: We comprehensively searched the PubMed, Embase and Scopus databases to identify relevant studies published until October 2023 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We applied a random-effects meta-analysis to the data gathered from the selected studies. RESULTS: Among the 460 initially identified studies, only eight met the eligibility criteria. The analysis of incidence revealed an event rate of 9.5% (95% CI, 4.4-19.5%) for a history of preterm singleton birth in the cohort of women with subsequent twin pregnancies. Subgroup analyses focused on the risk of preterm twin births (<37 weeks, <34 weeks and <32 weeks) in women with prior preterm singleton births. Our results revealed a significantly elevated risk of subsequent preterm twin births associated with prior preterm singleton births at <37 weeks (OR, 2.94; 95% CI, 1.99-4.33; p < .001), <34 weeks (OR, 1.89; 95% CI, 1.67-2.14; p < .001) and <32 weeks (OR, 2.51; 95% CI, 1.58-3.99; p < .001), without heterogeneity in the included studies. CONCLUSIONS: Our systematic analysis indicates a consistent and statistically significant association between a history of preterm singleton births and preterm twin births at various gestational ages. These findings underscore the importance of the obstetric history during assessments to predict the risk of preterm births in twin pregnancies. Clinicians should monitor pregnancies with a history of preterm singleton births, as targeted interventions and improved prenatal care can mitigate the risk of preterm birth during twin pregnancies.
Preterm birth, a global concern, prompted a study examining whether a prior preterm singleton birth raises the risk of preterm birth in subsequent twin pregnancies. Conducting a systematic review of 460 studies, only eight met the eligibility criteria. The meta-analysis revealed a 9.5% incidence of preterm singleton births in subsequent twin pregnancies. Further analysis demonstrated a significantly elevated risk of preterm twin births at <32 weeks for those with a history of preterm singleton births. The study concludes that a consistent and statistically significant association exists between prior preterm singleton births and increased preterm twin birth risk at various gestational ages. This underscores the importance of considering obstetric history in assessing preterm birth risk in twin pregnancies. Clinicians are advised to closely monitor pregnancies with a history of preterm singleton births for interventions targeted and improved prenatal care.
Asunto(s)
Embarazo Gemelar , Nacimiento Prematuro , Humanos , Embarazo , Femenino , Embarazo Gemelar/estadística & datos numéricos , Nacimiento Prematuro/epidemiología , Recurrencia , Factores de Riesgo , Edad Gestacional , AdultoRESUMEN
PURPOSE: Fetal sex is independently associated with pregnancy complications and impacts neonatal outcomes. Evidence suggests that females have an advantage over males, with a better outcome in the perinatal period. In addition, fetal outcome in twin gestations is also related to the intrauterine position of the fetus, such as the first, the presenting or second twin. It has been demonstrated that the neonatal outcome of the second fetus is worse than that of the first fetus. This study aimed to examine the influence of fetal sex on obstetric outcomes in twin pregnancies based on the location of the fetus in the uterus. METHODS: Retrospective study. Maternal and obstetric outcomes were compared among three groups: maleâmale, femaleâfemale, and maleâfemale groups. Comparisons of neonatal outcomes were performed among the four groups: male A-male B, male A-female B, female A-male B, and female A-female B. RESULTS: A total of 1073 twin gestations were included, comprising 288 maleâmale, 288 femaleâfemale, and 497 maleâfemale gestations. A greater percentage of neonates admitted to the NICU was observed for male fetuses than for female fetuses. Adverse composite neonatal outcome was more common in the maleâmale group than in the femaleâmale group and in the femaleâfemale group. CONCLUSION: Twin gestation with a first twin male tends to have worse neonatal outcomes than does twin gestation with a first twin female. The presence of a male co-twin increases the risk of adverse outcomes.
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Resultado del Embarazo , Embarazo Gemelar , Humanos , Femenino , Embarazo , Masculino , Embarazo Gemelar/estadística & datos numéricos , Estudios Retrospectivos , Recién Nacido , Resultado del Embarazo/epidemiología , Adulto , Factores SexualesRESUMEN
OBJECTIVES: To determine the effects of cerclage on twin pregnancies. METHODS: A multicenter, retrospective, cohort study was conducted at 10 tertiary centers using a web-based data collection platform. The study population included twin pregnancies delivered after 20 weeks of gestation. Patients with one or two fetal deaths before 20 weeks of gestation were excluded. Maternal characteristics, including prenatal cervical length (CL) and obstetric outcomes, were retrieved from the electronic medical records. RESULTS: A total of 1,473 patients had available data regarding the CL measured before 24 weeks of gestation. Seven patients without CL data obtained prior to cerclage were excluded from the analysis. The study population was divided into two groups according to the CL measured during the mid-trimester: the CL ≤2.5 cm group (n = 127) and the CL >2.5 cm group (n = 1,339). A total of 127 patients (8.7%) were included in the CL ≤2.5 cm group, including 41.7% (53/127) who received cerclage. Patients in the CL >2.5 cm group who received cerclage had significantly lower gestational age at delivery than the control group (hazard ratio (HR): 1.8; 95% confidence interval (CI): 1.11-2.87; p = .016). Patients in the CL ≤2.5 cm group who received cerclage had a significantly higher gestational age at delivery than the control group (HR: 0.5; 95% CI: 0.30-0.82; p value = .006). CONCLUSIONS: In twin pregnancies with a CL ≤2.5 cm, cerclage significantly prolongs gestation. However, unnecessary cerclage in women with a CL >2.5 cm may result in a higher risk of preterm labor and histologic chorioamnionitis although this study has a limitation originated from retrospective design.
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Cerclaje Cervical , Resultado del Embarazo , Embarazo Gemelar , Humanos , Femenino , Embarazo , Cerclaje Cervical/estadística & datos numéricos , Cerclaje Cervical/métodos , Estudios Retrospectivos , Embarazo Gemelar/estadística & datos numéricos , Adulto , Resultado del Embarazo/epidemiología , Medición de Longitud Cervical , Nacimiento Prematuro/prevención & control , Nacimiento Prematuro/epidemiología , Edad Gestacional , Incompetencia del Cuello del Útero/cirugíaRESUMEN
OBJECTIVE: To evaluate monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies conceived by assisted reproductive technology (ART) and conceived naturally. METHODS: We retrospectively analyzed the data on twin pregnancies conceived by ART from January 2015 to January 2022,and compared pregnancy outcomes of MCDA and DCDA twins conceived by ART with those of MCDA and DCDA twins conceived naturally, pregnancy outcomes between MCDA and DCDA twins conceived by ART, and pregnancy outcomes of DCT and TCT pregnancies reduced to DCDA pregnancies with those of DCDA pregnancies conceived naturally. RESULT: MCDA pregnancies conceived by ART accounted for 4.21% of the total pregnancies conceived by ART and 43.81% of the total MCDA pregnancies. DCDA pregnancies conceived by ART accounted for 95.79% of the total pregnancies conceived by ART and 93.26% of the total DCDA pregnancies. Women with MCDA pregnancies conceived by ART had a higher premature delivery rate, lower neonatal weights, a higher placenta previa rate, and a lower twin survival rate than those with MCDA pregnancies conceived naturally (all p < 0.05). Women with DCDA pregnancies conceived naturally had lower rates of preterm birth, higher neonatal weights, and higher twin survival rates than women with DCDA pregnancies conceived by ART and those with DCT and TCT pregnancies reduced to DCDA pregnancies (all p < 0.05). CONCLUSION: Our study confirms that the pregnancy outcomes of MCDA pregnancies conceived by ART are worse than those of MCDA pregnancies conceived naturally. Similarly, the pregnancy outcomes of naturally-conceived DCDA pregnancies are better than those of DCDA pregnancies conceived by ART and DCT and TCT pregnancies reduced to DCDA pregnancies.
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Resultado del Embarazo , Embarazo Gemelar , Técnicas Reproductivas Asistidas , Gemelos Monocigóticos , Humanos , Femenino , Embarazo , Embarazo Gemelar/estadística & datos numéricos , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Estudios Retrospectivos , Adulto , Gemelos Monocigóticos/estadística & datos numéricos , Corion , Nacimiento Prematuro/epidemiología , Gemelos Dicigóticos/estadística & datos numéricos , Recién Nacido , Placenta Previa/epidemiologíaRESUMEN
BACKGROUND: Twin pregnancy is associated with higher risks of adverse perinatal outcomes for both the mother and the babies. Among the many challenges in the follow-up of twin pregnancies, the mode of delivery is the last but not the least decision to be made, with the main influencing factors being amnionicity and fetal presentation. The aim of the study was to compare perinatal outcomes in two European centers using different protocols for twin birth in case of non-cephalic second twin; the Italian patients being delivered mainly by cesarean section with those in Belgium being routinely offered the choice of vaginal delivery (VD). METHODS: This was a dual center international retrospective observational study. The population included 843 women with a twin pregnancy ≥ 32 weeks (dichorionic or monochorionic diamniotic pregnancies) and a known pregnancy outcome. The population was stratified according to chorionicity. Demographic and pregnancy data were reported per pregnancy, whereas neonatal outcomes were reported per fetus. We used multiple logistic regression models to adjust for possible confounding variables and to compute the adjusted odds ratio (adjOR) for each maternal or neonatal outcome. RESULTS: The observed rate of cesarean delivery was significantly higher in the Italian cohort: 85% for dichorionic pregnancies and 94.4% for the monochorionic vs 45.2% and 54.4% respectively in the Belgian center (p-value < 0.001). We found that Belgian cohort showed significantly higher rates of NICU admission, respiratory distress at birth and Apgar score of < 7 after 5 min. Despite these differences, the composite severe adverse outcome was similar between the two groups. CONCLUSION: In this study, neither the presentation of the second twin nor the chorionicity affected maternal and severe neonatal outcomes, regardless of the mode of delivery in two tertiary care centers, but VD was associated to a poorer short-term neonatal outcome.
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Cesárea , Resultado del Embarazo , Embarazo Gemelar , Humanos , Femenino , Embarazo , Embarazo Gemelar/estadística & datos numéricos , Cesárea/estadística & datos numéricos , Estudios Retrospectivos , Adulto , Recién Nacido , Italia/epidemiología , Resultado del Embarazo/epidemiología , Bélgica/epidemiología , Parto Obstétrico/estadística & datos numéricos , Parto Obstétrico/métodos , Centros de Asistencia al Embarazo y al Parto/estadística & datos numéricosRESUMEN
OBJECTIVES: Among many risk factors for preeclampsia (PE), prepregnancy body mass index (BMI) is one of few controllable factors. However, there is a lack of stratified analysis based on the prepregnancy BMI. This study aimed to determine the influencing factors for PE and assess the impact of PE on obstetric outcomes in twin pregnancies by prepregnancy BMI. METHODS: This was a retrospective cohort study between January 1, 2017, and December 31, 2022, in Southwest China. Impact factors and associations between PE and obstetric outcomes were analyzed separately for twin pregnancies with prepregnancy BMI < 24kg/m2 (non-overweight group) and BMI ≥ 24kg/m2 (overweight group). RESULTS: In total, 3602 twin pregnancies were included, of which, 672 women were allocated into the overweight group and 11.8% of them reported with PE; 2930 women were allocated into the non-overweight group, with a PE incidence of 5.6%. PE had a negative effect on birthweight and increased the incidence of neonatal intensive care unit admission in both the overweight and non-overweight groups (43.0% vs. 28.0%, p = .008; 45.7% vs. 29.1%, p < .001). Among overweight women, PE increased the proportion of postpartum hemorrhage (15.2% vs. 4.4%, p < .001). After adjustments, multivariate regression analysis showed that excessive gestational weight gain (aOR = 1.103, 95% CI: 1.056-1.152; aOR = 1.094, 95% CI: 1.064-1.126) and hypoproteinemia (aOR = 2.828, 95% CI: 1.501-5.330; aOR = 6.932, 95% CI: 4.819-9.971) were the shared risk factors for PE in both overweight and non-overweight groups. In overweight group, in vitro fertilization was the other risk factor (aOR = 2.713, 95% CI: 1.183-6.878), whereas dichorionic fertilization (aOR = 0.435, 95% CI: 0.193-0.976) and aspirin use during pregnancy (aOR = 0.456, 95% CI: 0.246-0.844) were protective factors. Additionally, anemia during pregnancy (aOR = 1.542, 95% CI: 1.090-2.180) and growth discordance in twins (aOR = 2.451, 95% CI: 1.215-4.205) were connected with an increased risk of PE only in non-overweight twin pregnancies. CONCLUSIONS: Both discrepancy and similarity of impact factors on developing PE were found between overweight and non-overweight twin pregnancies in this study. However, the dosage and initiation time of aspirin, as well as twin chorionicity on the occurrence of PE in two subgroups, are still debated.
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Índice de Masa Corporal , Preeclampsia , Embarazo Gemelar , Humanos , Femenino , Embarazo , Preeclampsia/epidemiología , Embarazo Gemelar/estadística & datos numéricos , Estudios Retrospectivos , Adulto , China/epidemiología , Factores de Riesgo , Resultado del Embarazo/epidemiología , Recién Nacido , Sobrepeso/complicaciones , Sobrepeso/epidemiología , Peso al NacerRESUMEN
OBJECTIVES: To investigate factors associated with outcome of second twin during labour. METHODS: The study was a retrospective cohort study in a single tertiary centre in Malaysia from 2014 until 2018 involving all twin pregnancies delivered at or more than 24 weeks of gestation. RESULTS: Total of 409 twin pregnancies were included. Dichorionic twin comprises of 54.5â¯% (n=223) and 45.5â¯% (n=186) are monochorionic. Women with dichorionic pregnancies are significantly older (p<0.001), have more pre-existing medical disorders (p=0.011) and fetal structural anomalies (p=0.009). Monochorionic pregnancies are significantly more amongst Malay (p=0.01) and conceived spontaneously (p<0.001). There are significantly more fetuses both in cephalic presentation (p=0.026), birthweight discrepancy more than 20â¯% (p=0.038) and shorter mean inter-twin delivery duration (p=0.048) in monochorionic pregnancies. Second twin delivered with Apgar score <7 is significantly more in dichorionic pregnancies (p=0.006). The second twin is associated with lower birthweight, small for gestational age and arterial cord pH<7.25. Within the group of women who delivered both fetuses vaginally, there was significantly more second twins with intertwin delivery duration less than 30â¯min who were delivered vaginally without instrumentation (p=0.018). There was significantly more second twin with intertwin delivery duration of 30â¯min and more with arterial cord pH<7.25 (p=0.045). Those who delivered spontaneously had inter-twin delivery duration within 15-29â¯min. The outcome of second twin is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth. CONCLUSIONS: The neonatal outcome for the second twin at birth is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth in a cohort managed with non-active management of the second twin in Malaysia.
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Resultado del Embarazo , Embarazo Gemelar , Humanos , Femenino , Embarazo , Estudios Retrospectivos , Malasia/epidemiología , Embarazo Gemelar/estadística & datos numéricos , Adulto , Recién Nacido , Resultado del Embarazo/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Peso al Nacer , Gemelos DicigóticosRESUMEN
OBJECTIVE: To assess survival to discharge without severe neonatal morbidity by planned mode of delivery for twins born before 32 weeks of gestation. METHODS: The JUMODA (JUmeaux MODe d'Accouchement) study was a French national prospective, population-based, cohort study of twin deliveries conducted from February 2014 to March 2015. This planned secondary analysis included diamniotic twin pregnancies from 26 0/7 through 31 6/7 weeks of gestation. Exclusion criteria included contraindications to vaginal delivery and situations for which planned cesarean delivery is favored, and neonatal prognosis depends largely on the underlying pathology rather than the planned mode of delivery. The primary outcome was survival to discharge without severe neonatal morbidity (bronchopulmonary dysplasia, grade 3 or grade 4 intraventricular hemorrhage, periventricular leukomalacia, stage 2 or stage 3 necrotizing enterocolitis). The association between planned mode of delivery and primary outcome was assessed by multivariate Poisson regression model. A propensity-score approach with inverse probability of treatment weighting also was performed to control for indication bias. Subgroup analyses according to birth order and sensitivity analyses limited to spontaneous preterm births only were performed. RESULTS: Among 424 very preterm twin pregnancies, 192 (45.3%) had a planned cesarean delivery and 232 (54.7%) had a planned vaginal delivery. Survival to discharge without severe morbidity did not differ in the two groups: 308 of 384 (80.2%) after planned cesarean and 375 of 464 (80.8%) after planned vaginal delivery (crude relative risk 0.99; 95% CI 0.91-1.15; adjusted relative risk 1.02; 95% CI 0.93-1.11). After applying inverse probability of treatment weighting, planned cesarean delivery still was not associated with higher survival to discharge without severe neonatal morbidity than planned vaginal birth (relative risk 1.11; 95% CI 0.84-1.46). Subgroup and sensitivity analyses showed similar results. CONCLUSION: Planned cesarean delivery for very preterm twins is not associated with higher survival to discharge without severe neonatal morbidity than planned vaginal delivery. These results suggest that very preterm delivery should not be considered a per se indication for planned cesarean in twin pregnancies.
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Parto Obstétrico/estadística & datos numéricos , Recien Nacido Extremadamente Prematuro , Enfermedades del Prematuro/epidemiología , Embarazo Gemelar/estadística & datos numéricos , Adulto , Femenino , Francia/epidemiología , Humanos , Recién Nacido , Embarazo , Estudios ProspectivosRESUMEN
BACKGROUND: Evidence referring to the trade-offs between the benefits and risks of single embryo transfer (SET) versus double embryo transfer (DET) following assisted reproduction technology are insufficient, especially for those women with a defined embryo quality or advanced age. METHODS: A systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched based on established search strategy from inception through February 2021. Pre-specified primary outcomes were live birth rate (LBR) and multiple pregnancy rate (MPR). Odds ratio (OR) with 95% confidence interval (CI) were pooled by a random-effects model using R version 4.1.0. RESULTS: Eighty-five studies (14 randomized controlled trials and 71 observational studies) were eligible. Compared with DET, SET decreased the probability of a live birth (OR = 0.78, 95% CI: 0.71-0.85, P < 0.001, n = 62), and lowered the rate of multiple pregnancy (0.05, 0.04-0.06, P < 0.001, n = 45). In the sub-analyses of age stratification, both the differences of LBR (0.87, 0.54-1.40, P = 0.565, n = 4) and MPR (0.34, 0.06-2.03, P = 0.236, n = 3) between SET and DET groups became insignificant in patients aged ≥40 years. No significant difference in LBR for single GQE versus two embryos of mixed quality [GQE + PQE (non-good quality embryo)] (0.99, 0.77-1.27, P = 0.915, n = 8), nor any difference of MPR in single PQE versus two PQEs (0.23, 0.04-1.49, P = 0.123, n = 6). Moreover, women who conceived through SET were associated with lower risks of poor outcomes, including cesarean section (0.64, 0.43-0.94), antepartum haemorrhage (0.35, 0.15-0.82), preterm birth (0.25, 0.21-0.30), low birth weight (0.20, 0.16-0.25), Apgar1 < 7 rate (0.12, 0.02-0.93) or neonatal intensive care unit admission (0.30, 0.14-0.66) than those following DET. CONCLUSIONS: In women aged < 40 years or if any GQE is available, SET should be incorporated into clinical practice. While in the absence of GQEs, DET may be preferable. However, for elderly women aged ≥40 years, current evidence is not enough to recommend an appropriate number of embryo transfer. The findings need to be further confirmed.
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Transferencia de Embrión/efectos adversos , Transferencia de Embrión/métodos , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Resultado del Embarazo/epidemiología , Embarazo Gemelar/fisiología , Embarazo Gemelar/estadística & datos numéricos , Medición de Riesgo , Transferencia de un Solo Embrión/efectos adversos , Transferencia de un Solo Embrión/métodos , Transferencia de un Solo Embrión/estadística & datos numéricos , GemelosRESUMEN
To describe the perinatal outcomes of twin pregnancies with preterm premature rupture of membranes (PPROM) before 34 weeks' gestation and identify factors associated with discharge without severe or moderate-severe neonatal morbidity. This study was conducted as a retrospective analysis of twin pregnancies with PPROM occurring at 24 0/7 to 33 6/7 weeks' gestation. Perinatal outcomes were assessed by gestational age (GA) at PPROM and compared between PPROM and non PPROM twins. Factors associated with discharge without severe or moderate-severe neonatal morbidity were identified using logistic regression analysis. Of the 180 pregnancies (360 foetuses), only 17 (9.4%) women remained pregnant 7 days after PPROM. There were 10 (2.8%) cases of prenatal or neonatal death; 303 (84.2%) and 177 (49.2%) neonates were discharged without severe or moderate-severe morbidity, respectively. As GA at PPROM increased, the adverse obstetric and neonatal outcomes decreased, especially after 32 weeks. There was no significant difference in general neonatal outcomes between PPROM and non PPROM twins. The GA at PPROM and latency period were both significantly associated with discharge without severe or moderate-severe neonatal morbidity. Pregnancy complications and 5-min Apgar score < 7 increased severe neonatal morbidity. As GA at PPROM increased, the risk of adverse perinatal outcomes decreased. GA at PPROM and latency period were significantly associated with discharge without severe or moderate-severe neonatal morbidity.
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Rotura Prematura de Membranas Fetales/epidemiología , Resultado del Embarazo/epidemiología , Embarazo Gemelar/estadística & datos numéricos , Adulto , Femenino , Rotura Prematura de Membranas Fetales/mortalidad , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Modelos Logísticos , Edad Materna , Mortalidad Perinatal , Embarazo , Tercer Trimestre del Embarazo , Estudios Retrospectivos , GemelosRESUMEN
OBJECTIVE: To compare maternal and neonatal outcomes after preterm prelabor rupture of membranes (PROM) from 23 to 34 weeks of gestation in twin compared with singleton gestations. METHODS: We conducted a secondary analysis of an obstetric cohort of 115,502 individuals and their singleton or twin neonates born in 25 hospitals nationwide (2008-2011). Those with preterm PROM from 23 0/7 through 33 6/7 weeks of gestation were included; neonates with major fetal anomalies were excluded. The coprimary outcomes for this analysis were composite maternal morbidity (chorioamnionitis, blood transfusion, postpartum endometritis, wound infection, sepsis, venous thromboembolism, intensive care unit admission, or death) and composite major neonatal morbidity (persistent pulmonary hypertension, intraventricular hemorrhage grade III or IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II or III, bronchopulmonary dysplasia, stillbirth subsequent to admission, or neonatal death before discharge). Logistic regression was used to estimate unadjusted and adjusted odds ratios (ORs) with 95% CIs for twin compared with singleton gestations. RESULTS: Of 1,531 (1.3%) individuals who met eligibility criteria for this analysis, 218 (14.2%) had twin gestations. The median gestational age at preterm PROM was similar between those with twins and singletons (31.2 weeks [interquartile range 27.4-32.9] vs 30.6 weeks [interquartile range 26.9-32.7], P=.23); however, those with twin gestations had a shorter median latency period (2.0 days [interquartile range 1.0-5.0] vs 3.0 days [interquartile range 2.0-8.0], P<.001). After adjustment for potential confounders, odds of experiencing composite maternal morbidity (17.9% vs 19.3%, adjusted OR 0.97, 95% CI 0.66-1.42) or composite neonatal morbidity (20.4% vs 20.5%, OR 0.97, 95% CI 0.72-1.31) did not differ between groups. CONCLUSION: In a large, diverse cohort, the likelihood of composite maternal or neonatal morbidity per fetus after preterm PROM was similar for twin and singleton gestations.
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Rotura Prematura de Membranas Fetales/epidemiología , Resultado del Embarazo/epidemiología , Embarazo Gemelar/estadística & datos numéricos , Adulto , Corioamnionitis/epidemiología , Estudios de Cohortes , Endometritis/epidemiología , Enterocolitis Necrotizante/epidemiología , Femenino , Rotura Prematura de Membranas Fetales/mortalidad , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Evaluación de Resultado en la Atención de Salud , Mortalidad Perinatal , Embarazo , Nacimiento Prematuro/epidemiología , Sepsis/epidemiología , Tromboembolia Venosa/epidemiología , Infección de Heridas/epidemiología , Adulto JovenRESUMEN
BACKGROUND: People whose singleton pregnancy is affected by hypertensive disorders of pregnancy (HDP) are at risk of future cardiovascular disease. It is unclear, however, whether this association can be extrapolated to twin pregnancies. We aimed to compare the association between HDP and future cardiovascular disease after twin and singleton pregnancies. METHODS: We conducted a population-based retrospective cohort study that included nulliparous people in Ontario, Canada, 1992-2017. We compared the future risk of cardiovascular disease among pregnant people from the following 4 groups: those who delivered a singleton without HDP (referent) and with HDP, and those who delivered twins either with or without HDP. RESULTS: The populations of the 4 groups were as follows: 1 431 651 pregnant people in the singleton birth without HDP group; 98 631 singleton birth with HDP; 21 046 twin birth without HDP; and 4283 twin birth with HDP. The median duration of follow-up was 13 (interquartile range 7-20) years. The incidence rate of cardiovascular disease was lowest among those with a singleton or twin birth without HDP (0.72 and 0.74 per 1000 person-years, respectively). Compared with people with a singleton birth without HDP, the risk of cardiovascular disease was highest among those with a singleton birth and HDP (1.47 per 1000 person-years; adjusted hazard ratio [HR] 1.81 [95% confidence interval (CI) 1.72-1.90]), followed by people with a twin pregnancy and HDP (1.07 per 1000 person-years; adjusted HR 1.36 [95% CI 1.04-1.77]). The risk of the primary outcome after a twin pregnancy with HDP was lower than that after a singleton pregnancy with HDP (adjusted HR 0.74 [95% CI 0.57-0.97]), when compared directly. INTERPRETATION: In a twin pregnancy, HDP are weaker risk factors for postpartum cardiovascular disease than in a singleton pregnancy.
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Enfermedades Cardiovasculares/epidemiología , Hipertensión Inducida en el Embarazo/epidemiología , Embarazo Gemelar/estadística & datos numéricos , Adulto , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Ontario , Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
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.
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Parto Obstétrico/tendencias , Transferencia de Embrión/métodos , Fertilización In Vitro/métodos , Edad Materna , Embarazo Gemelar/estadística & datos numéricos , Técnicas Reproductivas Asistidas/clasificación , Gemelos Monocigóticos/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Italia , Persona de Mediana Edad , Embarazo , Inyecciones de Esperma Intracitoplasmáticas/métodos , Factores de Tiempo , Adulto JovenRESUMEN
Obstetric ultrasound performed according to standards from its prescription to the report is a guarantee of quality. The aim of our study was to take stock of obstetrical ultrasounds in order to make rational the ultrasound follow-ups of pregnancy. This was a descriptive cross-sectional study with retrospective data collection through the reports of obstetrical ultrasounds performed from the 1st January 2016 to 31st December 2018. Of the 13,487 ultrasounds in the study period, 2,355 were obstetric ultrasounds, constituting 1746% of the ultrasound activity. The mean gestational age was 27.54 years (± 6.19). The CHU Bogodogo was the requesting structure for 86.88%. Paramedics were prescribers in 66.47%. Third trimester ultrasounds made up 57.06%. Gestational age in 12.99% was greater than 37 weeks while in 66.37% gestational age was greater than 24 weeks. Prenatal follow-up was indicated in 54.48%. Pregnancies were progressive in 97.49%. Twin pregnancies represent 2.72% and ultrasound pathological pregnancies 11.80%. Obstetric Doppler was performed in 2.12% with pre-eclampsia as the main indication (52%). There was 1.18% malformation with nervous system involvement in 60.71%. Through this inventory, the training of prescribers of obstetric ultrasound appears essential. The establishment of an observatory of obstetric ultrasound practices would be an asset for the quality of these medical examinations.
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Complicaciones del Embarazo/diagnóstico por imagen , Embarazo Gemelar/estadística & datos numéricos , Ultrasonografía Prenatal/estadística & datos numéricos , Adolescente , Adulto , Niño , Estudios Transversales , Femenino , Edad Gestacional , Humanos , Persona de Mediana Edad , Preeclampsia/diagnóstico por imagen , Preeclampsia/epidemiología , Embarazo , Complicaciones del Embarazo/epidemiología , Estudios Retrospectivos , Ultrasonografía Doppler/métodos , Adulto JovenRESUMEN
The purpose of this study was to develop a dynamic model to predict the risk of spontaneous preterm birth at < 32 weeks in twin pregnancy. A retrospective clinical study of consecutively asymptomatic women with twin pregnancies from January 2017 to December 2019 in two tertiary medical centres was performed. Data from one centre were used to construct the model, and data from the other were used to evaluate the model. Data on maternal demographic characteristics, transvaginal cervical length and funnelling during 20-24 weeks were extracted. The prediction model was constructed with independent variables determined by multivariate logistic regression analyses. After applying specified exclusion criteria, an algorithm with maternal and biophysical factors was developed based on 88 twin pregnancies with a preterm birth < 32 weeks and 639 twin pregnancies with a delivery ≥ 32 weeks. It was then evaluated among 34 pregnancies with a preterm birth < 32 weeks and 252 pregnancies with a delivery ≥ 32 weeks in a second tertiary centre without specific training. The model reached a sensitivity of 80.00%, specificity of 88.17%, positive predictive value of 50.33% and negative predictive value of 96.71%; ROC characteristics proved that the model was superior to any single parameter with an AUC of 0.848 (all P < 0.005). We developed and validated a dynamic nomogram model to predict the individual probability of early preterm birth to better represent the complex aetiology of twin pregnancies and hopefully improve the prediction and indication of interventions.
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Nomogramas , Embarazo Gemelar/estadística & datos numéricos , Nacimiento Prematuro/epidemiología , Adulto , Medición de Longitud Cervical/métodos , Medición de Longitud Cervical/estadística & datos numéricos , Cuello del Útero/diagnóstico por imagen , Femenino , Humanos , Valor Predictivo de las Pruebas , Embarazo , Segundo Trimestre del Embarazo , Curva ROC , Estudios Retrospectivos , Medición de Riesgo/métodos , Ultrasonografía/estadística & datos numéricosRESUMEN
OBJECTIVE: To estimate the chorionic villus sampling (CVS)-related risk of fetal loss in twin pregnancy after adjustment for chorionicity, nuchal translucency thickness (NT), intertwin discordance in crown-rump length (CRL), maternal demographic characteristics and serum pregnancy-associated plasma protein-A (PAPP-A) and free ß-human chorionic gonadotropin (ß-hCG). METHODS: This was a multicenter study from eight fetal medicine units in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar. Data were obtained prospectively from women with twin pregnancy undergoing routine ultrasound examination at 11-13 weeks' gestation. Multivariable logistic regression analysis with backward stepwise elimination was used to examine whether CVS provided a significant independent contribution to the prediction of risk of fetal loss after adjusting for maternal and pregnancy characteristics, including maternal age, racial origin and weight, method of conception, smoking status, parity, chorionicity, intertwin discordance in CRL, fetal NT ≥ 95th percentile and free ß-hCG and PAPP-A multiples of the median. Similarly, within the CVS group, multivariable logistic regression analysis was used to investigate the effect of the number of intrauterine needle insertions and size of the needle on the risk of fetal loss. RESULTS: The study population of 8581 twin pregnancies undergoing ultrasound examination at 11-13 weeks' gestation included 316 dichorionic and 129 monochorionic twins that had CVS. First, in twin pregnancies undergoing CVS, compared to those not undergoing CVS, there was a 2-fold increased risk of fetal loss at < 24 weeks' gestation and of loss at any stage in pregnancy. Second, the factors providing a significant independent contribution to the prediction of miscarriage or fetal loss in twin pregnancy were increased maternal weight, black racial origin, monochorionicity, and more so monoamnionicity, large intertwin discordance in CRL and increased fetal NT, and, in the case of fetal loss at any stage, there was also a contribution from assisted conception and low serum PAPP-A. Third, after adjustment for maternal and pregnancy characteristics, CVS did not provide a significant contribution to the risk of fetal loss. Fourth, in twin pregnancies that had CVS, there was no significant contribution to fetal loss from the number of intrauterine needle insertions or needle size. CONCLUSION: The 2-fold increased risk of fetal loss following CVS in twin pregnancy can, to a great extent, be explained by maternal and pregnancy characteristics rather than the invasive procedure itself. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Aborto Espontáneo/etiología , Muestra de la Vellosidad Coriónica/efectos adversos , Embarazo Gemelar/estadística & datos numéricos , Diagnóstico Prenatal/estadística & datos numéricos , Gemelos/estadística & datos numéricos , Aborto Espontáneo/epidemiología , Adulto , Corion , Gonadotropina Coriónica Humana de Subunidad beta/sangre , Largo Cráneo-Cadera , Femenino , Edad Gestacional , Humanos , Modelos Logísticos , Londres/epidemiología , Medida de Translucencia Nucal , Embarazo , Primer Trimestre del Embarazo/sangre , Embarazo Gemelar/sangre , Proteína Plasmática A Asociada al Embarazo/análisis , Factores de Riesgo , Ultrasonografía Prenatal/estadística & datos numéricosRESUMEN
RESEARCH QUESTION: Is it possible to identify monochorionic twin pregnancies before blastocyst transfer based on maternal or embryo characteristics registered by time lapse? DESIGN: A retrospective cohort study including women who received fertility treatment (nâ¯=â¯6501) between 2010 and 2019 at two fertility clinics in central Denmark. The treatment resulted in 2239 pregnancies after single embryo transfer (SET) and, of those, 43 (1.92%) were monochorionic twins. Baseline characteristics, information on assisted reproductive technology and ultrasonic findings at gestational week 8 were collected on all women. Furthermore, a blinded time lapse annotation analysis was conducted by two independent laboratory technicians on a total of 85 embryos. A total of 22 embryos leading to monochorionic pregnancies were matched with 63 embryos leading to singleton pregnancies. RESULTS: A monochorionic twin rate of 1.92% was found. No significant difference was found in maternal age, the use of intracytoplasmic sperm injection compared with IVF, indication for treatment or other maternal characteristics. In the blinded annotation analysis, inner cell mass grade A was associated with an increased risk of twinning (Pâ¯=â¯0.04) in fresh embryos. The s3 division timing was found to be significantly shorter in fresh twin compared with singleton embryos (Pâ¯=â¯0.006). No other time lapse parameters were found to be characteristic of twin embryos. CONCLUSION: To the best of our knowledge, this is the first blinded annotation study to identify aspects in time lapse resulting in monochorionic twins after SET. Whether inner cell mass grade A and s3 reflect a biological background for monochorionic twinning merits further investigation.
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Embarazo Gemelar/estadística & datos numéricos , Transferencia de un Solo Embrión/estadística & datos numéricos , Imagen de Lapso de Tiempo , Adulto , Femenino , Humanos , Embarazo , Estudios RetrospectivosRESUMEN
BACKGROUND: Preeclampsia is a common obstetric complication. The rate of preeclampsia is increased in twin pregnancies. The aim of this study was to assess the clinical risk factors for developing preeclampsia in twin pregnancies. METHODS: A case-control study was carried out among women with twin pregnancies who delivered at gestational age more than 23 weeks at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, from 2003 to 2019. The data were retrieved from electronic medical records. Multivariate logistic regression analysis was used to find the risk factors. RESULTS: A total of 1,568 twin pregnancies were delivered during the study period and 182 cases (11.6%) developed preeclampsia. 172 cases with preeclampsia and 516 controls were selected for analysis. After certain variables were adjusted in the multivariate logistic regression analysis, the clinical factors associated with preeclampsia in twin pregnancies were nulliparity (adjusted odds ratio (OR) 1.57, 95% confidence interval (CI) 1.02-2.41) and chronic hypertension (adjusted OR 6.22, 95%CI 1.98-19.57). Low gestational weight gain was a significant protective factor against the development of preeclampsia (adjusted OR 0.50; 95%CI 0.32-0.77). CONCLUSION: The clinical risk factors for developing preeclampsia in twin pregnancies were nulliparity and chronic hypertension. These risk factors are of value to identify twin pregnant women at risk for preeclampsia and in implementing primary prevention.
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Preeclampsia/epidemiología , Embarazo Gemelar/estadística & datos numéricos , Medición de Riesgo/métodos , Adulto , Estudios de Casos y Controles , Femenino , Edad Gestacional , Humanos , Recién Nacido de Bajo Peso , Modelos Logísticos , Edad Materna , Paridad , Embarazo , Tailandia/epidemiologíaRESUMEN
Vasa previa (VP) is a rare and life-threatening condition for the fetus. It is associated with increased perinatal mortality rates. The current study sought to retrospectively analyze the perinatal outcomes of VP in singleton and multiple pregnancies between January 1, 2013 and December 31, 2019 at a tertiary hospital in west China. One hundred and fifty-seven cases of VP were identified, including 131 singletons, 23 twins and 3 triplets. VP in 20 cases was diagnosed at delivery. There were 183 live births. Neonatal mortality was significantly higher in cases with no prenatal diagnosis (9.7% vs. 1.3%, p = 0.035). There was a significantly higher rate of NICU admission, premature infant and neonatal pneumonia in cases with prenatal diagnosis (p < 0.05). Among twin pregnancies with VP as a prenatal diagnosis, there were significantly earlier gestational age at admission (31.1 vs. 34.1 weeks, p = 0.000) and delivery age (33.4 vs. 35.3 weeks, p = 0.000) than those among singleton pregnancies. The neonatal mortality in twins with prenatal diagnosis was significantly higher than that in singletons (0% vs. 6.9%, p = 0.037). Early hospitalization of VP in the third trimester may be reasonable. The data suggest that the timing of elective delivery at 34-36 weeks in singletons and 32-34 weeks in twins may be suitable. It should be emphasized to make corresponding optimal delivery time according to individual differences for the women, especially in twin pregnancy.
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Mortalidad Perinatal , Embarazo Triple/estadística & datos numéricos , Embarazo Gemelar/estadística & datos numéricos , Vasa Previa/epidemiología , Adulto , Cesárea , China/epidemiología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Edad Materna , Embarazo , Estudios Retrospectivos , Centros de Atención Terciaria/estadística & datos numéricos , Ultrasonografía Prenatal/estadística & datos numéricos , Vasa Previa/diagnósticoRESUMEN
OBJECTIVE: Current guidelines for maternal weight gain in twin pregnancy were established in the absence of evidence on its longer-term consequences for maternal and child health. We evaluated the association between weight gain in twin pregnancies and the risk of excess maternal postpartum weight increase, childhood obesity, and child cognitive ability. METHODS: We used 5-year follow-up data from 1000 twins born to 450 mothers in the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative U.S. cohort of births in 2001. Pregnancy weight gain was standardized into gestational age- and prepregnancy body mass index (BMI)-specific z-scores. Excess postpartum weight increase was defined as ≥10 kg increase from prepregnancy weight. We defined child overweight/obesity as BMI ≥ 85th percentile, and low reading and math achievement as scores one standard deviation below the mean. We used survey-weighted multivariable modified Poisson models with a log link to relate gestational weight gain z-score with each outcome. RESULTS: Excess postpartum weight increase occurred in 40% of mothers. Approximately 28% of twins were affected by overweight/obesity, and 16 and 14% had low reading and low math scores. There was a positive linear relationship between pregnancy weight gain and both excess postpartum weight increase and childhood overweight/obesity. Compared with a gestational weight gain z-score 0 SD (equivalent to 20 kg at 37 weeks gestation), a weight gain z-score of +1 SD (27 kg) was associated with 6.3 (0.71, 12) cases of excess weight increase per 1000 women and 4.5 (0.81, 8.2) excess cases of child overweight/obesity per 100 twins. Gestational weight gain was not related to kindergarten academic readiness. CONCLUSIONS: The high prevalence of excess postpartum weight increase and childhood overweight/obesity within the recommended ranges of gestational weight gain for twin pregnancies suggests that these guidelines could be inadvertently contributing to longer-term maternal and child obesity.