Obstetrical and perinatal complications of twin pregnancies: is there a link with the type of infertility treatment?

INTRODUCTION: The aim of this study was to compare the maternal and perinatal data from spontaneous twin pregnancies with twin pregnancies conceived via assisted reproductive technology, and to evaluate the outcomes depending on the type of treatment. MATERIAL AND METHODS: A historical cohort of all twin live births between 1997 and 2014 was used to create two groups: spontaneous pregnancies and pregnancies after infertility treatment (ovulation induction, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection). The population characteristics and pregnancy, childbirth, and neonatal complications were compared, and the data were adjusted for age, parity, chorionicity, and the mother's body mass index to assess only the impact of the infertility treatments. RESULTS: In total, 1580 twin pregnancies were included, with 575 requiring assisted conception. We did not observe any differences between the assisted conception pregnancies and the spontaneous twin pregnancies with regard to the obstetric and childbirth complications and neonatal outcomes. In addition, there were no statistically significant differences between the types of infertility treatment. CONCLUSION: After adjusting for the maternal parameters and chorionicity, the twin pregnancies conceived via assisted reproductive technology were not at an increased risk of obstetric and neonatal complications. Moreover, the type of treatment did not alter the obstetric and neonatal complications. Therefore, the higher complication rate was related to the patient's medical specifics, rather than to the infertility treatment.

Cesarean during labor: Is induction a risk factor for complications?

INTRODUCTION: Evaluate the impact of labor induction on maternal complications following caesarean section during labor. MATERIAL AND METHODS: Retrospective, single-center study between 2015 and 2017. Were included singleton pregnancies who had cesarean section during labor after 37WG. Labor induction procedures included either transcervical balloon catheters or prostaglandins. Degree of emergency of the cesarean was decided according to color code (green, orange and red). We identified and compared intra and postoperative complications according to the mode of labor onset, and then to the mode of labor induction. RESULTS: 882 patients were included, 416 with spontaneous labor and 464 with labor induction. No significant difference was found for postoperative complications between the two groups. Patients with spontaneous labor had fewer green-code caesareans than patients with elective induction (29.3% vs. 40.3% p<0.001) and had more uterine pedicle injuries (6.3% vs. 3.0% p=0.022). Nevertheless, no difference was found for postpartum hemorrhage (PPH) between these two groups (41.59% vs. 43.32% p=0.60). The subgroup study of patients with labor induction showed that those necessitating 2 methods of labor induction had more severe PPH (22.2% vs. 8.1% p after Bonferroni correction = 0.002). CONCLUSIONS: Elective induction does not result in an increased risk of cesarean section during labor complications. Only the use of prostaglandin following transcervical balloon catheter increased the risk of severe postpartum hemorrhage.

Impact of customized growth curves on screening for small for gestational age twins.

OBJECTIVE: The choice of a growth curve determines the screening for small-for-gestational-age (SGA) fetuses and little data is available on SGA twins. Our aim was to evaluate small-for-gestational-age (SGA) detection rate in twin pregnancies and assess whether the use of a customized curve allowed better identification of SGA fetuses. STUDY DESIGN: Retrospective study including all twins between 2010 and 2013. Two groups were formed: the SGA and the non-SGA group. Four curves were compared: Hadlock's curve, a customized curve, EPOPé M0 and EPOPé M1. We defined a composite neonatal complication criterion (transfer to intensive care unit, respiratory distress and death). RESULT: 472 fetuses were included with a 34.3% prevalence of SGA. Hadlock's curve showed better sensitivity for the detection of SGA <10th percentile (67.3% vs. 63%, 59.9% and 57.4% respectively). Diagnostic Odd Ratio were comparable for the detection of SGA. For the composite variable, there was a significant difference between the 2 groups using a customized curve adjusted for fetal sex (EPOPé M1). CONCLUSION: The EPOPé (M0 and M1) and customized curves do not improve screening for SGA infants below the 10th percentile. The reduced effectiveness of customized curves can be related to the greater impact of placentation or cord insertion on the potential for fetal growth.