Birth In Multiple Pregnancies Research Articles

Преждевременные роды при многоплодной беременности после ЭКО с использованием аутологичных и донорских ооцитов

Objective. To analyze the rate and pattern of preterm birth in multiple pregnancy after in vitro fertilization (IVF) using donor and autologous oocytes. Patients and methods. The rate of preterm birth in 213 women with a dichorionic diamniotic twin pregnancy was analyzed. All patients were divided into three groups: IVF-DO – 68 women who became pregnant after IVF with donor oocytes, IVF-AO – 73 women who became pregnant after IVF with autologous oocytes, and NTP – 72 women with natural twin pregnancy. The study included only those women whose pregnancy resulted in birth. Results. Most of the patients in the IVF-DO group were over 40 years of age, while the other groups were dominated by women under 35 years of age. There was no statistically significant increase in the overall rate of preterm birth in the IVF groups compared to the NTP group. However, pregnancy termination before 34 weeks’ gestation was significantly more frequent in patients in the IVF-DO group (OR = 3.28; 95% CI = 0.99–10.86). There were also significantly higher rates of pregnancy complications such as pre-eclampsia (PE) (OR = 10.42; 95% CI = 2.94–36.94), gestational hypertension (GH) (OR = 11.16; 95% CI = 3.16–39.43), intrahepatic cholestasis of pregnancy (ICP) (OR = 4.67; 95% CI = 0.95–22.82), and placental abruption (PA) (OR = 9.47; 95% CI = 1.15–77.86) in the IVF-DO group. Conclusion. Multiple pregnancy after IVF with donor oocytes include a combination of several significant and age-independent risk factors for preterm birth. Key words: preterm birth, IVF, oocyte donation, multiple pregnancy, twins

Working conditions in women with multiple pregnancy—the impact on preterm birth and adherence to guidelines: a prospective cohort study

Women with multiple pregnancies are at risk for maternal complications such as preterm birth. Hazardous working conditions, such as physically demanding work and long and irregular working hours, might increase the risk of preterm birth. This study primarily aimed to determine whether certain working conditions up to 20 weeks of pregnancy increase the risk of preterm birth in multiple pregnancies. The secondary objective was to evaluate whether the working conditions of Dutch women with multiple pregnancy have been adjusted to the guidelines of the Netherlands Society of Occupational Medicine. We performed a prospective cohort study alongside the ProTWIN trial, a multicenter randomized controlled trial that assessed whether cervical pessaries could effectively prevent preterm birth. Women with paid work of >8 hours per week completed questionnaires concerning general health and working conditions between 16 and 20 weeks of pregnancy. Univariable and multivariable logistic regression analyses were performed to identify work-related factors associated with preterm birth (32-36 weeks' gestation) and very preterm birth (<32 weeks' gestation). We analyzed a subgroup of participants who worked for more than half of the week (>28 hours). We calculated the proportion of women who reported work-related factors not in accordance with guidelines. We studied 383 women, of whom 168 (44%) had been randomized to pessary, 142 (37%) to care as usual, and 73 (19%) did not participate in the randomized part of the study. After adjusting for confounding variables, working >28 hours was associated with very preterm birth (n=33; 78%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.1), and irregular working times were associated with preterm birth (n=26, 17%) (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.1) and very preterm birth (n=10; 24%) (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-7.3). Within a subgroup of 213 participants working >28 hours per week, multivariable analysis showed that irregular working times (n=16; 20%) (adjusted odds ratio, 3.5; 95% confidence interval, 1.2-10.1) and no/little freedom in performance of tasks (n=23; 28%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.3-7.3) were associated with preterm birth. Irregular working times (n=9; 27%) (adjusted odds ratio, 3.4; 95% confidence interval, 1.0-11.1), requiring physical strength (n=9; 27%) (adjusted odds ratio, 5.3; 95% confidence interval, 1.6-17.8), high physical workload (n=7; 21%) (adjusted odds ratio, 3.9; 95% confidence interval, 1.1-13.9), and no/little freedom in performing tasks (n=10; 30%) (adjusted odds ratio, 3.2; 95% confidence interval, 1.1-9.6) were associated with very preterm birth. Before 20 weeks of pregnancy, 224 (58.5%) women with multiple pregnancy continued to work under circumstances that were not in accordance with the guidelines. In our cohort study, nearly 60% of women with multiple pregnancy continued to work under circumstances not in accordance with the guidelines to avoid physical and job strain and long and irregular working hours. Irregular hours were associated with preterm and very preterm birth, and long hours were associated with preterm birth.

O12 - Multiple birth mental health outcomes throughout pregnancy, delivery and postnatally

While there is awareness that multiple birth pregnancies and postnatal experiences are more challenging generally, little is known of the mental health impacts. To explore multiple birth mothers pregnancy experience and mental health outcomes during pregnancy, following delivery and postnatally. An open online anonymous survey was used to collect data from multiple birth parents, 1006 responses were collected. 713 completed the survey fully, providing very detailed responses to open-ended questions, whilst 293 provided high level responses only. The challenges of a multiple birth pregnancy was associated with high levels of mental distress and mental health problems. 73.3% of respondents noted that they experienced challenges during their pregnancy, and of these, 84.7% cited these challenges as directly impacting upon their emotional or mental health. Despite the challenges, 70% of these respondents did not seek treatment or a diagnosis. At birth, 73.7% of those surveyed had a caesarean delivery and another 2.3% had at least one baby delivered via caesarean. Almost 28% of respondents reporting experiencing a traumatic birth, with over 60% not seeking support or treatment. The heightened risk of postnatal mental health problems and emotional distress is indicated with 69% of respondents experiencing stress, anxiety and/or depression in the postnatal period. In addition, over three quarters (77.5%) experienced feelings of isolation. The results reveal the significantly higher risks of emotional and mental health distress for parents of multiple births. This begins in the antenatal period, and continues at birth and throughout the postnatal period. The results highlight the imperative need for information, screening and early detection, support and treatment. Given the high prevalence of emotional and mental health distress, low rates of help-seeking, and isolation, the need for continued advocacy to support the unique needs of this population group is urgently needed.

Assisted Reproductive Technology Surveillance - United States, 2018.

Assisted Reproductive Technology Surveillance - United States, 2018.

“Relaxin-dependent” way of implementing spontaneous preterm labor in multiple pregnancies: The involvement of placental relaxin 2

BACKGROUND: Despite numerous studies, the etiopathogenesis of preterm birth in multiple pregnancy remains unclear, which determines the low effectiveness of measures for the prevention of preterm birth. This fact makes it necessary to study possible ways of implementing preterm birth in multiple pregnancies and to search for new biomarkers of their pathogenetic links. Experimental and clinical studies have demonstrated the contribution of the pleiotropic hormone relaxin to the regulation of a wide range of physiological processes and its role in the implementation of the pathogenetic mechanisms of pregnancy complications, primarily premature birth. The proven autocrine / paracrine mechanism of placental relaxin action, which implements important local effects, determines the prospects for studying the contribution of its dysregulation to the implementation of spontaneous preterm labor in multiple pregnancies.&#x0D; MATERIALS AND METHODS: A morphological examination of 92 placentas from 46 deliveries of dichorionic diamniotic twins was performed: 24 of them were spontaneous premature births and 22 spontaneous term births. Histological examination of placentas along with immunohistochemical verification of relaxin 2 expression in the chorionic villus of the dichorial twins placentas were carried out.&#x0D; RESULTS: Histological examination of the dichorionic twins placentas revealed that those from spontaneous preterm birth were characterized by a higher frequency of chronic placental insufficiency with reduced compensatory and adaptive mechanisms and more pronounced circulatory disorders in the circulatory bed of the villous tree, when compared to placentas from spontaneous term labor. The first verification of relaxin 2 expression in the chorionic villi of the dichorionic twins placenta showed the role of the peptide in the initiation of spontaneous preterm birth. The relative area of relaxin 2 expression in spontaneous preterm labor was significantly higher (p 0.05) compared to that in spontaneous term labor.&#x0D; CONCLUSIONS: The data obtained confirm the hypothesis put forward about the involvement of placental relaxin in the pathogenesis of spontaneous preterm labor in multiple pregnancies. The authors were the first to propose the definition of a relaxin-dependent way of implementing spontaneous preterm labor. To help define new preventive strategies, the prospects for further studies of the role and significance of relaxin in the implementation of pathogenic processes involved in spontaneous preterm birth in multiple pregnancies have been outlined.

Integral assessment of markers of the local infectious and inflammatory process in women with preterm birth in multiple pregnancies

Hypothesis/Aims of study. Premature birth in multiple pregnancies remains an important object of research, since it is the main factor in poor perinatal outcomes, and their heterogeneous mechanisms determine the ineffectiveness of prediction and prevention methods. In the pathogenesis of premature birth, as is known, one of the leading links is inflammation caused by infections of the lower genital tract (40%). In multiple pregnancies, which in most cases occur as a result of assisted reproductive technology treatment (70%) and are mainly accompanied by complications, pregravid preparation and antenatal observation include more careful control and correction of local infectious and inflammatory processes. In this regard, the persisting high rate of premature birth in multiple pregnancies (about 54%) demonstrates the ambiguity of the opinion about the suppressive role of the infectious factor in the induction of premature birth and determines the need for studying its contribution to multifactorial genesis. The aim of this study was to conduct an integral assessment of markers of the local infectious and inflammatory process in women with PB in multiple pregnancies.&#x0D; Study design, materials and methods. We performed a comprehensive study of the bacteriological composition of the lower genital tract discharge using microscopic, bacteriological, and molecular biological methods (Femoflor 16 test) and assessed the local inflammatory status (ImmunoQuantex test) in 30 pregnant women with dichorionic diamniotic twins. The main group consisted of women with premature birth (n = 13), the control group comprising those with term birth (n = 16), while patients with induced premature birth (n = 2) were not included in the comparative analysis.&#x0D; Results. This study was the first to determine the features of vaginal microbiocenosis and the local immune status in women with premature birth in multiple pregnancies. In general, the study cohort had a low inflammatory status and normal or intermediate types of vaginal biotope. The most common disruptions (24.1%) were vaginal dysbiosis, expressed in a small amount of Lactobacillius spp., and non-specific vaginitis associated with Mycoplasma hominis. The local immune status of women with premature birth was characterized by a relative decrease in the mRNA expression of such innate immunity genes as IL1B, TNF, TLR4, and GATA3. An integrated assessment of the studied parameters based on the data obtained allowed us to build a mathematical model for predicting premature birth with the probability of 87.6%.&#x0D; Conclusion. The integral assessment of infectious and inflammatory markers is important from the standpoint of not only their possible identification as predictors, but also a general understanding of the genesis of premature birth.

COMPARISON OF PERINATAL OUTCOME IN TWIN PREGNANCY WITH AND WITHOUT CERVICAL CERCLAGE

Background: The incidence of multifetal pregnancies has registered increase globally. Babies born from multiplebirth pregnancies are much more likely to result in premature birth than those from single pregnancies. Knowledge of role of cervical cerclage in preventing preterm birth especially in twin pregnancy can be helpful to prevent complication related to preterm birth and ultimately of low birth weight babies. Methods: Depending upon who opt for the procedure 100 patients were divided equally into two groups: 1)Twin pregnancy with cervical cerclage; 2)Twin pregnancy without cervical cerclage. We measured maternal outcomes which include time for which patient required to be hospitalized, maternal pyrexia, cervical or bladder injury and other maternal morbidity and perinatal outcomes which include preterm delivery (delivery before 37 completed weeks), low birth weight (birth weight ≤2000 g), IUGR, perinatal mortality, indicators of perinatal morbidity (APGAR scores and neonatal unit admission), stillbirth, second trimester loss and presence of congenital malformations. Results: In Study group 22% delivered before 34 weeks of gestation, 46% delivered between 34 and 37 weeks of gestation, 32% delivered after 37 weeks of gestation compared to 44%, 48% and 8% respectively in Control group. The mean gestational age at delivery was 35.3 weeks in Study group and was 33.2 weeks in Control group. In study group 47% neonates had birth weight less than 2Kg and in Control group 69% neonates had birth weight less than 2Kg. In Study group 95% had Apgar score more than 6 whereas in Control group 86% had APGAR score more than 6. The mean APGAR for Study group was 8.5 and for Control group was 7.5. 45% neonates had complications in Study group whereas 67% neonates in Control group. Overall Low birth weight was most common complications in both the groups. Respiratory distress was more common in Control group. Conclusions: In spite of close vigilance, preterm birth in twin gestation is common and unpredictable. It is difficult to predict those who may require cervical cerclage although all multiple pregnancies are at high risk. Cerclage should be considered an option for patients with twin pregnancies in the second trimester to prolong the duration of gestation as close to term as possible.

The effect of early administration of rectal progesterone in IVF/ICSI twin pregnancies on the preterm birth rate: a randomized trial

BackgroundThe rate of multiple pregnancies in IVF/ICSI ranges from 20 to 30%. The incidence of preterm birth in multiple pregnancies is as high as 60% and is even higher in pregnancies conceived after IVF & ICSI. The effect of progesterone on prevention of preterm birth in twins is controversial. Our group has proven a positive effect in reduction of preterm birth, by starting progesterone from the mid-trimester, in exclusively IVF/ICSI singleton pregnancies but not twins. The purpose of our current study was to explore the effect of earlier administration of natural progesterone, in IVF/ICSI twin pregnancies starting at 11–14 weeks for prevention of preterm birth.MethodsThis is a double-blind, placebo controlled, single center, randomized clinical trial. Women with dichorionic twin gestations, having an IVF/ICSI trial were randomized to receive natural rectal progesterone (800 mg daily) vs placebo, starting early from 11 to 14 weeks. They also received oral and vaginal antimicrobial agents as part of our routine treatment for vaginitis and urinary tract infection. They were randomized regardless of cervical length and had no previous history of preterm birth or known Mullerian anomalies. The primary outcome was spontaneous preterm birth rate before 37 weeks. The secondary outcome was; spontaneous preterm birth before 34, 32, 28 weeks and neonatal outcome.ResultsA total of 203 women were randomized to both groups, final analysis included 199 women as 4 were lost to follow up. The base line characteristics as well as gestational age at delivery were not significantly different between the study and the placebo group (34.7 ± 3.6 vs 34.5 ± 4.5, P = 0.626). Progesterone administration was not associated with a significant decrease in the spontaneous preterm birth rates before 37 weeks (73.5% vs 68%, P = 0.551), before 34 (20.6% vs 21.6%, P = 0.649), before 32 (8.8% vs 12.4%, P = 0.46) & before 28 (4.9% vs 3.1%, P = 0.555) weeks.ConclusionsRectal natural progesterone starting from the first trimester in IVF/ICSI twin pregnancies did not reduce spontaneous preterm birth.Trial registrationThe trial was registered on 31 January 2014 at www.ISRCTN.com, number 69810120.

Многофакторное прогнозирование реализации преждевременных родов при многоплодии

Многофакторное прогнозирование реализации преждевременных родов при многоплодии

Evaluating the Clinical Effect of Female Blood Donors of Child-Bearing Age on Maternal and Neonatal Outcomes: A Cohort Study.

Iron deficiency is a global problem in women of child-bearing age and is associated with adverse maternal and newborn outcomes. Repeated blood donations deplete iron stores and decrease hemoglobin levels. However, the clinical impact of iatrogenic iron deficiency on mothers and neonates due to blood donation is uncertain. The objective of this study was to assess the association between repeated blood donations in female donors of child-bearing age and the associated risk of adverse maternal and neonatal outcomes. We undertook an observational cohort study of all women who delivered a live or stillborn infant in Ontario, Canada, between 1 January 2010 and 31 March 2012 using birth record data from the Better Outcomes Registry & Network, Canadian Blood Services, and the Institute of Clinical Evaluative Sciences. Only a woman's first pregnancy within the study time frame was included for analysis. We excluded women <18 years or >50 years of age at the time of delivery and multiple birth pregnancies. Data on all female donors who made whole blood donations between 1 January 2007 and 31 March 2012 were obtained from Canadian Blood Services. The primary newborn outcome was diagnosis of a small-for-gestational-age neonate (less than 10th centile). Secondary outcomes were preterm birth, stillbirth, APGAR <4 at 5 minutes, cord pH <7, neonatal death, maternal transfusion, infection, preeclampsia, gestational hypertension, gestational diabetes, placental abruption, and maternal death. Regression models evaluated the effect of repeated donation and the time interval between donations and conception on neonatal and maternal outcomes while adjusting for important clinical and demographic risk factors. A total of 260 037 women delivered live or stillborn singleton infants between 1 January 2010 and 31 March 2012. A total of 7919 (3.0%) women were blood donors, with a mean of 2.43 ± 2.10 lifetime donations. Mean maternal age at the time of delivery for nondonors and donors was 30.30 ± 5.38 and 29.74 ± 4.94 years, respectively. Small for gestational age occurred in 23 706 (9.4%) of neonates born to nondonors and 526 (6.6%) of neonates born to donors. There was a reduction in the risk of small for gestational age with increasing number of lifetime donations (adjusted odds ratio 0.89 [0.86-0.92] per additional donation). For the prespecified secondary outcomes, we observed a reduction in the risk of low birth weight (adjusted odds ratio 0.95 [0.91-0.98] per additional donation). There was no association with other secondary neonatal or maternal outcomes except for maternal hypertension. Proximity of donation to conception had no effect on risk of a small-for-gestational age neonate. Our data suggest that there is no increased risk of deleterious neonatal and maternal outcomes associated with repeated blood donations prior to pregnancy. Although possibly a result of a healthy donor effect, our findings are reassuring to female donors and their children as well as to clinicians and blood system stakeholders seeking to inform policy decisions.

Delisting Full Coverage for In Vitro Fertilization in Quebec

On 28 November 2015, the Quebec government withdrew full coverage for its assisted procreation program that had been previously covered since 2010. The previously approved legislation under Bill 26 aimed to decrease neonatal intensive-care unit costs associated from multiple birth pregnancies and to increase the number of live-births in the province by funding up to six natural in vitro fertilization (IVF) cycles and implementing a single-embryo-transfer (SET) policy. One factor that contributed to delisting IVF services in Quebec was Quebec’s Commission of Health and Well-Being’s report that concluded that IVF services costed $63 million/per year and resulted in 1300 births/per year. Taken within the larger context of Quebec’s goal to optimize financial ressources within the healthcare system and to reduce the province’s growing debt in 2015, the government withdrew fully-funded IVF services, embryo storage and drug costs and imposed stricter criteria on who could access IVF based on a woman’s age. The government provided tax credits based on a person/couples income, again based on specific criteria. Since implementation of Bill 20, IVF rates have dropped dramatically within the province and multiple-birth pregnancies are on the rise once more. Ultimately, while delisting IVF services in Quebec provided cost-savings in the province’s budget, the law poses serious setbackts to individuals that cannot afford out-of-pocket payments and raises ethical concerns regarding infertility as a medical condition. The newly elected government in 2018 is currently studying the possibility of reinstating full coverage of oneIVF cycle by 2020.

Prevention and therapy of threatened preterm birth in multiple pregnancy

Preterm birth in multiple pregnancy is an important medical, economic and social problem. Currently, more than half of twins are born prematurely, which puts them at high risk of developing neonatal diseases causing lifelong disability and social maladjustment. In this regard, reducing the frequency of preterm multiple births is an important task of modern obstetrics. Improving perinatal outcomes of multiple pregnancies can only be achieved using the most effective measures that have a good evidence base. At the same time, numerous studies on the effectiveness of therapeutic interventions aimed at prolonging multiple pregnancies have reported contradictory results. This review included most of the randomized controlled trials of methods for the prevention and treatment of threatening preterm birth in multiple pregnancies, as available in PubMed, Google Academy, Elibrary, and the Cochrane Central Register of Controlled Trials. Thus far, studies on the use of bed rest, prophylactic tocolysis, most of the progestins, and cervical cerclage in multiple pregnancy have shown no efficacy in reducing the risk of premature birth. However, encouraging data were obtained on improving neonatal outcomes of multiple pregnancies using vaginal progesterone and an obstetric pessary, but these results require additional confirmation in larger multicenter randomized studies. Further clinical trials are needed to develop algorithms for timely diagnosis and adequate treatment of threatened preterm birth in case of multiple pregnancy, including the use of the most rational preventive and therapeutic methods that have a high evidence level.

National Guidance Updated on Multiple Birth Pregnancies

The National Institute for Health and Care Excellence has reviewed the evidence and made new recommendations on fetal complications, preterm birth, timing of birth and intrapartum care for multiple birth pregnancies

The effects of tocolysis on neonatal septic death in women with PPROM: a retrospective cohort study.

In women with preterm premature rupture of membranes (PPROM), particularly those with suspected chorioamnionitis, the benefit of tocolysis on neonatal outcome remains unclear. Our purpose was to evaluate the effect of tocolysis on neonatal septic death in women with PPROM with and without chorioamnionitis. A retrospective cohort study was used to address our study objective. We created a cohort consisting of all live births between 24 and 32weeks' gestation that were registered in the Linked Birth and Infant Death data files (2009-2013) from the United States. Multivariate logistic regression was used to evaluate the effect of tocolysis on neonatal septic death at 7 and 28days in births with and without chorioamnionitis. Of the 46,968 births that met our inclusion criteria, tocolysis was administered to 6264 (13.3%). Tocolysis was more commonly prescribed to Caucasians, smokers, in multiple birth pregnancies, and to women with a history of preterm births. Tocolysis was not significantly associated with neonatal septic death at 7days (OR 0.66, 95% CI 0.39-1.13) or at 28days (OR 0.85, 95% CI 0.60-1.19). This was consistent in pregnancies with and without chorioamnionitis. Furthermore, tocolysis was associated with a reduced risk of neonatal septic death at 7days when administered between 24 and 27weeks' gestation (OR 0.44, 95% CI 0.22-0.88). In the setting of PPROM, tocolysis does not appear to increase the risk of neonatal septic death at 7 and 28days. Therefore, consideration should be given to its administration if clinically indicated.

МОЖЛИВОСТІ ЛІКУВАННЯ ЗАГРОЗИ ПЕРЕДЧАСНИХ ПОЛОГІВ ПРИ БАГАТОПЛІДНІЙ ВАГІТНОСТІ З ВИКОРИСТАННЯМ СУБЛІНГВАЛЬНОЇ ФОРМИ МІКРОНІЗОВАНОГО ПРОГЕСТЕРОНУ

Мета дослідження – оцінити ефективність застосування сублінгвальної форми мікронізованого прогестерону (Лютеіна) у жінок із багатоплідною вагітністю з високим ризиком загрози передчасних пологів.Матеріали та методи. Обстежено 85 вагітних із двійнятами з ознаками невиношування у термінах 22–36 тижнів вагітності, котрі склали основну групу, сформовано дві підгрупи: Іа – 43 жінки, котрі отримували в комплексі лікування загрози передчасних пологів мікронізований прогестерон сублінгвально; підгрупа Іб – 42 вагітні, які не отримували під час лікування препарати прогестерону. Ретроспективно було проаналізовано 40 історій передчасних пологів при одноплідній вагітності (група порівняння). В основній групі було проведено загальноклінічне та біохімічне обстеження вагітних, визначення вмісту в сироватці крові АЛТ, АСТ, рівнів білірубіну та прогестерону. Проведений аналіз перебігу вагітності, пологів, післяпологового періоду та стану неонатальної адаптації новонароджених в обстежуваних вагітних.Результати дослідження та їх обговорення. Доведені основні чинники ризику розвитку передчасних пологів при багатоплідній вагітності, а також роль інфекційного анамнезу, даних трансвагінальної цервікометрії, неповного обстеження та несвоєчасного початку лікування загрози передчасних пологів, недостатньої профілактики ускладнень при багатоплідній вагітності. Динаміка вкорочення шийки матки була значно повільнішою у пацієнток Іа підгрупи, яким було призначено мікронізований прогестерон, це є ефективним методом профілактики та лікування невиношування у жінок із багатоплідною вагітністю, зниження частоти пізнього аборту та передчасних пологів, перинатальних втрат. Встановлено, що в жінок основної групи рівні АЛТ та АСТ, а також загального білірубіну не відхилялися від норми. Відмічено зниження рівня прогестерону в обох підгрупах. У вагітних Іа підгрупи на тлі лікування мікронізованим прогестероном відмічалося суттєве зростання рівня прогестерону у сироватці крові вже на 3-тю добу лікування до (1109±27) нмоль/л, а до кінця першого тижня лікування цей показник зростав до рівня (1280±39) нмоль/л, тоді як у Іб підгрупі його динаміка не змінювалась ((886±29) нмоль/л та, відповідно, (891±33) нмоль/л). Використання сублінгвальної форми мікронізованого прогестерону у період вираженої клінічної симптоматики загрози передчасних пологів при багатоплідній вагітності дозволяє отримати максимально швидкий терапевтичний ефект, що сприяє швидкому усуненню клінічних симптомів, регресу ультразвукових маркерів загрози переривання вагітності та запобігає подальшому прогресуванню структурних змін з боку шийки матки.Висновки. 1. При ознаках загрози передчасних пологів застосування сублінгвальної форми мікронізованого прогестерону дає можливість швидко відновити рівень прогестерону в сироватці крові до фізіологічних показників і тим самим знизити частоту передчасних пологів та покращити перинатальні наслідки у новонароджених. 2. Застосування сублінгвальної форми мікронізованого прогестерону у вагітних із загрозою передчасних пологів не впливає на функцію печінки. 3. Комплексна терапія загрози передчасних пологів із використанням мікронізованого прогестерону має високу ефективність терапевтичної дії та може бути рекомендована для широкого використання, сприяє коротшому періоду перебування в стаціонарі, зменшенню кількості ускладнень.

Factors Associated with Stillbirth Autopsy in Georgia and Utah, 2010-2014: The Importance of Delivery Location.

This article determines whether demographic, delivery, and medical factors are associated with stillbirth autopsy performance in Georgia and Utah. This study used fetal death certificates from 2010 to 2014 to determine which factors are associated with stillbirth autopsy performance in Georgia and Utah. Analyses were conducted using logistic regression with a predicted margins approach. The stillbirth autopsy rate was low in both states: 11.9% in Georgia (N = 5,610) and 23.9% in Utah (N = 1,425). In Utah, the autopsy rate significantly declined during the study period (p = 0.01). Stillbirths delivered outside of large metropolitan areas were less likely to receive an autopsy (medium/small metropolitans: prevalence ratioGA [PR] = 0.57, 95% confidence interval [CI]: 0.48-0.68 and PRUT = 0.48, CI: 0.38-0.59; nonmetropolitans: PRGA = 0.57, CI: 0.43-0.75 and PRUT = 0.37, CI: 0.21-0.63). In Georgia, autopsies were less common among stillbirths of Hispanic (vs. white) women (PR = 0.57, CI: 0.41-0.79), at earlier (vs. later) gestational ages (PR = 0.59, CI: 0.51-0.69), and of multiple birth pregnancies (PR = 0.71, CI: 0.53-0.96). Despite strong evidence supporting the value of stillbirth autopsies, autopsy rates were low, especially outside metropolitan areas, where approximately half of stillbirths were delivered.

Bittersweet: a qualitative exploration of mothers’ experiences of raising a single surviving twin

Loss of a child from a multiple birth pregnancy is not uncommon yet the idiographic experience of parents who have lost a single twin from a multiple birth pregnancy is underexplored. This novel study sought to explore the experiences of mothers bereaved after loss of a twin from a multiple birth pregnancy, focusing on the dual challenges of parenting and grieving. Eighteen mothers at least 12 months post loss were recruited from a private UK based Facebook page dedicated to supporting parents after loss from a multiple birth. Eligible mothers completed an independent qualitative open-ended survey to explore maternal experiences of loss. Data were analysed using Thematic Analysis. Findings represented a sense of duality for participants, with mothers experiencing conflict between roles and identities as well as the nature of their loss. Key themes identified include ‘Narrating a story of family and loss’, ‘Finding a place for the twins within the family’ and ‘A changing sense of self’. Findings fit with theoretical conceptualisations of bereavement that acknowledge retaining relationships with the deceased. Practically, suggestions for supporting mothers to identify stock answers to often asked questions about family make up were suggested.

Spontaneous preterm birth prevention in multiplepregnancy.

Key content Twin pregnancies are associated with a three‐fold greater perinatal mortality than singleton pregnancies. Prematurity is a main contributor, with 50% of twin pregnancies delivering before 37 weeks and 10% delivering before 32 weeks of gestation.The aetiology of preterm delivery in twin pregnancies is likely multifactorial and different from that of singletons.Cervical cerclage reduces preterm birth rates in singletons but has mixed results in twins with some studies showing harm.The use of progesterone to prevent preterm birth in singletons has conflicting results and has not been proven to prevent preterm birth in twins. Studies continue to determine whether the cervical pessary is effective in preventing preterm birth in multiple pregnancies.There is a paucity of data available on the prevention of preterm birth in triplets/higher order multiples but similar principles to twin pregnancy apply. Learning objectives To review the burden of preterm birth in multiple pregnancy.To understand the methods available for preventing preterm birth in multiple pregnancies and the evidence surrounding the use of each one.To be aware of the use of the Arabin pessary.

Prevalence of multiple birth in Isfahan, Iran.

Background:According to increasing rate of using assisted reproductive technology (ART) which result in higher rates of multiple birth and natal difficulties, we aimed to determine the prevalence rate of multiple birth pregnancies.Materials and Methods:A descriptive cross-sectional study evaluating birth files in 2009–2010 of main hospitals of Isfahan, Iran.Results:Among 31640 files' studies, 614 cases of multiple birth pregnancies were investigated. The product of these pregnancies were 1286 (50.2% females) infants including 557 twins (17.6/1000), 56 triplets (1.8/1000), and one case of quadruple (0.03/1000). Infants weigh <2500 g were 84.9% of all. Mothers had a mean age of 27.9 ± 4.9 which 30.4% of them had a positive history of using ART.Conclusion:The prevalence of multiple birth pregnancies is growing. The need for more mother and child care is important. Using ART world wide is leading more multiple birth which could be a cause for more complicated pregnancies.

Congenital Cytomegalovirus Infection After a Multiple Birth Pregnancy.

Congenital cytomegalovirus (cCMV) infection is an important cause of hearing loss and neurodevelopment delay. While data on vertical transmission and neonatal outcome after singleton pregnancy with cCMV are well established, only scarce reports have addressed cCMV in multiple birth pregnancies. Furthermore, no studies have yet compared the outcome after birth and long-term follow-up of children with cCMV born after a singleton versus multiple pregnancies. Infant outcome after birth of symptomatic versus asymptomatic infection was compared for infants born with cCMV after multiple (study group) and singleton (control group) pregnancies in a 1:2 ratio. Of 508 infants diagnosed with cCMV, 25 (4.9%) were born after a multiple pregnancy. Children in the study and control groups did not differ in terms of specific prenatal CMV investigations including amniocentesis and brain magnetic resonance imaging studies. However, prematurity rates were significantly higher in the study compared with control group (52% vs. 4%, P < 0.001). There was a higher rate of symptomatic cCMV infection in the study group than in the controls (48% vs. 14%, P < 0.001). Hearing impairment at birth was also more frequent in the study group (32% vs. 8%, P = 0.016). A long-term follow-up demonstrated that children in the study group had higher rates of neurologic sequelae (hearing impairment or neurodevelopmental delay) compared with children in the control group (20% vs. 4%, P = 0.016). Infants with cCMV born after multiple birth pregnancies are born earlier and have a higher risk of symptomatic disease at birth and worse long-term neurologic outcome than those born after a singleton pregnancy. This important group of children warrants meticulous prenatal and postnatal care.