Delivery In Singleton Pregnancies Research Articles

Difficulty of embryo transfer does not predict failed attempt at vaginal delivery in singleton pregnancies

Difficulty of embryo transfer does not predict failed attempt at vaginal delivery in singleton pregnancies

Interleukin-6 and C-reactive protein levels in the amniotic fluid as indicators of preterm delivery in Turkish women

Objective: The aim of this study was to determine the value of amniotic fluid interleukin-6 (IL-6) and C-reactive protein (CRP) levels in the prediction of preterm delivery in singleton pregnancies without any known risk factors for preterm delivery in Turkish women. Materials and Methods: Patients in the present perinatology department who underwent mid-trimester genetic amniocentesis due to evidence of increased risk of aneuploidy in their prenatal serum screening tests were included in the study. A sample of amniotic fluid from each patient was assessed for IL-6 and CRP. Concentrations of IL-6 and CRP in the amniotic fluid of preterm delivery and term delivery groups were compared. Results: Of 151 singleton pregnancies, 142 participants were included in the study. The participants were assigned to either the preterm or term delivery group based on pregnancy outcome. IL-6 levels in the amniotic fluid were significantly higher in the preterm delivery group, and there was a statistically significant negative correlation between IL-6 concentrations in the amniotic fluid and gestational age at delivery (correlation coefficient (CC): -18.5%, p p = 0.068). Conclusion: Measuring IL-6 in the amniotic fluid can identify women at risk of preterm delivery. Because it is not acceptable to perform amniocentesis for this screening, it is more convenient for patients in whom genetic amniocentesis is performed.

The diagnostic value of cervicovaginal and serum ferritin levels in midgestation time to predict spontaneous preterm delivery.

Background:The aim of this study was to determine diagnostic value of cervicovaginal ferretin and serum ferretin levels at midgestation time in predicting preterm delivery in singleton pregnancies.Patients and Methods:A diagnostic test study through a prospective cohort design was carried out on 300 singleton pregnant women in 2012. A blood sample was obtained from all the patients within 22-24 gestational weeks for laboratory assessment of serum ferretin, and cervicovaginal sample was also taken to assess cervicovaginal ferritin level. Ferritin levels were compared between term and preterm deliveries at 37, 34 and 32 weeks of gestation. Receiver operating characteristics (ROC) curves were plotted to assess the diagnostic test values.Results:Mean serum ferritin level was 55.38 [standard deviation (SD 23.8)] ng/mL in term deliveries versus a mean of 91.27 (SD 25.2) ng/mL in preterm deliveries, which showed a statistically significant difference (P < 0.001). The ferritin levels in cervicovaginal term delivery group had mean of 11.29 (SD 16.2) ng/mL compared with a mean of 21.95 (SD 10.1) ng/mL among those with preterm delivery before 37 weeks of gestational age(P < 0.001). The cervicovaginal ferritin level had a moderate to good diagnostic value with an area under curve being above 0.8 for all assessments. The serum ferritin level had a moderate to good diagnostic value with an area under curve being above 0.8 for all assessments. In both tests, its diagnostic value was higher for predicting preterm delivery at earlier gestational age.Conclusions:The results of this study indicate that high levels of serum and cervicovaginal ferritin in singleton pregnancies may alert the clinician of the risk of preterm delivery. Serum and cervicovaginal ferritin measurement at midgestation may be used as a predictive scale for preterm delivery in singleton pregnancies.

Umbilical choline and related methylamines betaine and dimethylglycine in relation to birth weight

Low birth weight (LBW) is associated with increased morbidity and mortality for the newborn and risk of chronic disease in adulthood. Choline plays an essential role in the integrity of cell membranes, methylation reactions, and memory development. We examined whether choline, betaine, and dimethylglycine (DMG) concentrations were associated with LBW in Dutch women. Blood was sampled from umbilical cords (UCs) at delivery in singleton pregnancies (n = 1,126). Maternal blood was sampled at 30-34 wk of gestational age (GA) (n = 366). We calculated birth weights standardized for GA and defined LBW as standardized birth weight ≤ 2,500 g. Maternal concentrations were lower as compared with UC concentrations and were not associated with birth weight. UC choline and betaine were inversely associated with birth weight (β = -60 (-89, -31) and β = -65 (-94, -36), respectively), whereas UC DMG was positively associated with birth weight (β = 35 (6.1, 63)). Odds ratios for LBW were 4.12 (1.15, 14.78), 5.68 (1.24, 25.91), and 0.48 (0.09, 2.65) for the highest UC choline, betaine, and DMG quartiles, respectively, as compared with the lowest quartiles. We observed an increased risk of LBW with increased umbilical choline and betaine in venous UC blood. These results might reflect a change in choline consumption or metabolism or a disturbed placental function.

First-Trimester Screening for Spontaneous Preterm Delivery with Maternal Characteristics and Cervical Length

Objective: It was the aim of this study to examine the potential value of cervical length at 11–13 weeks’ gestation in the prediction of spontaneous preterm delivery. Methods: This was a screening study for spontaneous preterm delivery in singleton pregnancies from cervical length measured by transvaginal ultrasound at 11–13 weeks’ gestation. The performance of screening for preterm delivery by cervical length alone and with maternal characteristics was estimated. Results: In the 9,974 pregnancies included in the study, spontaneous delivery before 34 weeks occurred in 104 (1.0%) cases. Multivariate regression analysis in the term delivery group demonstrated that for the log₁₀ cervical length, significant independent contributions were provided by fetal crown-rump length, maternal height, age, racial origin and parity. The median cervical length multiple of the median (MoM), corrected for maternal characteristics, was significantly lower in the preterm (0.892 MoM, 95% CI 0.829–0.945) than in the term delivery group (0.994 MoM, 95% CI 0.919–1.082; p < 0.0001). In screening by a combination of maternal characteristics and cervical length, the estimated detection rate of preterm delivery was 54.8% (95% CI 44.7–64.6), at a false-positive rate of 10%. Conclusions: Effective first-trimester screening for spontaneous early preterm delivery can be provided by a combination of maternal characteristics and cervical length.

Optimal time for delivery with preterm premature rupture of membranes from 32 to 36 6/7 weeks

Objective. To evaluate the optimal time for delivery in singleton pregnancies with preterm premature rupture of membranes (PPROM) when delivered between 32 and 36 6/7 weeks gestational age (GA).Study design. We performed a retrospective cohort study of all singleton pregnancies with PPROM who delivered between 32 and 36 6/7 weeks gestation at our institution. We matched the delivery and NICU datasets to determine composite morbidity (COMP MORB) and NICU length of stay (LOS) stratified by weeks of gestation. COMP MORB was defined as one or more of: bronchopulmonary dysplasia, respiratory distress syndrome, necrotizing entercolitis, intraventricular hemorrhage, dissiminated intravascular coagulation, and culture proven sepsis. We used χ2 and student ‘t’ test as appropriate and a receiver operating characteristc curve (ROC).Results. There were 195 newborns with PPROM with a range of 30 babies at 36 weeks to a high of 53 at 34 weeks. The mean (±SD) NICU LOS was 22.5 (±9.9) days at 32 weeks, 17.8 (±10.0) days at 33 weeks, 14.8 (±11.0) days at 34 weeks, 4.5 (±4.7) days at 35 weeks, and 1.5 (±4.4) days at 36 weeks (p <0.0001). There was no difference in duration of ROM by GA with a range of 6.8 to 1.9 by week (p = NS). The ROC curve had a cut point for COMP MORB at 34.1 weeks GA (sens = 95%, FPR 48.6%, area under curve 0.782, p = 0.0002).Conclusion. Our study suggests that delivery of PPROM pregnancies at 34.1 weeks GA avoids 95% of composite morbidity, and delivery after 35 weeks GA will decrease the NICU LOS.

Preterm delivery in IVF versus ICSI singleton pregnancies: a national population-based cohort

Objectives To assess the risk of spontaneous and iatrogenic preterm delivery in singleton pregnancies when comparing in vitro fertilization (IVF) pregnancies with intracytoplasmic sperm injection (ICSI) pregnancies. Study design A national population-based cohort study using Norwegian Medical Birth Register data during 1999 through 2006 was designed. The cohort included 5824 singleton pregnancies after IVF and ICSI treatment. Multinomial logistic regression analyses were used to calculate risk estimates. Results There were no differences in maternal complicating factors such as pre-eclampsia, hypertension and diabetes between the IVF and ICSI pregnancies. However, IVF pregnancies had a 60% increased risk of moderately (32 + 0 days–36 + 6 days gestational weeks) iatrogenic preterm delivery (OR: 1.6, 95%CI: 1.1–2.2) and a 40% increased risk of iatrogenic preterm delivery <37 weeks (OR: 1.4, 95%CI: 1.02–1.9) compared to ICSI pregnancies. Conclusion IVF pregnancies were at increased risk of moderately iatrogenic preterm delivery when compared to ICSI pregnancies.

P282 Cervical length measurement in 22–24 weeks of gestation as a prediction factor of preterm delivery in singleton pregnancies

P282 Cervical length measurement in 22–24 weeks of gestation as a prediction factor of preterm delivery in singleton pregnancies

Risk of low birth weight and preterm delivery in singleton pregnancies conceived by women with and without a history of infertility

OBJECTIVE: To determine predictors and risk of low birth weight (LBW) and preterm delivery (PTD) in singleton pregnancies conceived by women with a history of infertility. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: The study was conducted at 11 infertility clinics in Northern California. Data were collected on 983 women who carried singleton pregnancies to ≥ 20 weeks gestation between 1994 and 1998. These women either conceived naturally following a history of infertility or they conceived using infertility treatment. The fertile comparison group (n= 1008) was identified through California Vital Statistics records and matched on singleton status, maternal age, and county of delivery. RESULTS: There was a significant difference in the frequency of LBW between the three groups of women (chi-square 9.12, p=.01). There were more women in the infertile with treatment group compared to the fertile comparison group who delivered a LBW infant. There was no significant difference (chi-square 1.23, p= .541) in the frequency of PTD between the three groups of women. Women with a history of infertility who gave birth to a LBW infant were 1.55 (95% CI 1.03, 2.34) times more likely to have undergone infertility treatment to conceive their pregnancy than those women with a history of infertility who conceived a pregnancy without treatment, controlling for maternal age, parity, gestational diabetes, and obesity. Nulliparity was a significant predictor of LBW; women who gave birth to a LBW infant were 1.51 times (95% CI 1.07, 2.14) more likely to be nulliparous controlling for maternal age, gestational diabetes and obesity, regardless of fertility status. CONCLUSIONS: Women with a history of infertility who undergo infertility treatment and conceive a singleton pregnancy may be at increased risk for giving birth to a LBW infant, but there does not appear to be an increased risk for preterm delivery.

OC102: The clinical significance of early (&lt; 20 weeks) versus late (20–24 weeks) detection of a sonographic short cervix in asymptomatic women

performed according to FMF recommendations, at 21–23 weeks of gestation. The patients were afterwards followed-up until the time of delivery. The value of the measurement was then assessed as a predictor of PD. Results: Among singleton pregnancies the mean CL at the time of the scan was 37.37 ± 7.7 mm. The incidence of PD 25 mm (38.7 ± 6.4 mm; P 25 mm in twin pregnancies. Conclusions: Mid-pregnancy CL measurement can be of predictive value for earlier delivery in singleton pregnancy after IVF, but seems less important in twin pregnancies. Further studies on larger groups of IVF patients are required to evaluate its accurate predictive value.

Risk factors associated with preterm birth according to gestational age at birth

To identify and quantify risk factors associated with preterm birth, stratified by gestational age at birth. Three case-control analyses were done. Controls were pregnancies of > or =37 weeks of gestational age at birth. Cases were defined as: <28, 28-32, 33- <37 weeks of gestational age at birth respectively in the three case-control analyses. Women were categorized according to whether they carried single or multiple infants. Obstetrical conditions (placenta previa, placental abruption), and maternal hypertension were significantly associated with preterm delivery in all case-control analyses (adjusted OR between 1.34-19.56, p < 0.05). Leading risk factors for preterm delivery in singleton pregnancies were placental abruption and placenta previa (adjusted ORs 4.85 and 4.13, p < 0.05). For multiple pregnancies they were polyhydramnios and maternal hypertension (adjusted ORs 4.39 and 2.45, p < 0.05). Obstetrical conditions during the pregnancy and maternal hypertension are important risk factors for preterm birth.

Die Episiotomie: Protektiv- oder Risikofaktor beim schweren Dammriss?

Purpose: Is an episiotomy a protective or a risk factor for severe perineal lacerations; which other obstetric influencing factors exist? Patients and Methods: Retrospective analysis of the perinatal data from Berlin from 1993 to 1999. Study inclusion criteria: vaginal delivery in singleton pregnancies. Setting up of two study subgroups: vaginal delivery of singletons, cephalic presentation >34/0 gestational weeks, birth weight 2500 to 4000 g. Separate analysis of the primi- (subgroup 1) and multiparae (subgroup 2). Multivariate analysis with stepwise logistic regression. Identification of factors which correlate with severe perineal lacerations. Results: 74.7% of all vaginal deliveries of singletons (n= 128745) fulfilled the inclusion criteria. In spontaneous deliveries, the frequency of episiotomy was 60.8 %,in vacuum extraction and forceps delivery 95.3 and 98.6% respectively. Severe perineal lacerations were significantly more frequent in vaginal-operative deliveries than in spontaneous vaginal delivery. If no episiotomy was incised, perineal lacerations stage 3/4 were less frequent in spontaneous and vacuum extraction deliveries. Following regression analysis, severe perineal lacerations were less frequent in primipara if the active period of labour is <10 minutes, if no episiotomy is incised, in vacuum than in forceps extraction, if fetal head circumference is <36cm, and if no further traumas of the birth canal occur. Results were similar for multi-parae: severe perineal lacerations were less frequent if the active period of labour is ≤ 10 minutes, if no episiotomy is incised, and if no vaginal operative delivery occurs. Conclusions: Episiotomies seem to carry one of the highest risks for a severe perineal laceration among the avoidable risk factors. Therefore, use of an episiotomy must be restricted to well-justified cases. When considering perineal protection, vacuum extraction should be preferred to forceps extraction.

Perinatal outcome of pregnancies after assisted reproduction: A case-control study

Objective: We conducted a case-control study of all pregnancies obtained with assisted reproduction technology in the Dutch-speaking part of Belgium from 1992 until 1997 to investigate differences in peripartum obstetric events and the perinatal outcome. Study Design: Three thousand fifty-seven singleton and 1241 twin pregnancies were studied. About 90% of pregnancies resulted from in vitro fertilization; the remainder resulted from intracytoplasmic sperm injection. Control subjects were selected from a regional register and were matched for maternal age, parity, fetal sex, plurality, and date of delivery. The main outcome measures were duration of gestation, birth weight, perinatal death, perinatal morbidity, incidence of congenital malformations, and incidence of cesarean delivery. Results: Odds ratios and 95% confidence intervals were 2.6 (1.4-4.8) for perinatal mortality, 3.5 (2.2-5.7) for birth before 33 weeks of gestation, and 1.7 (1.5-1.9) for cesarean delivery in singleton pregnancies that resulted after in vitro fertilization. Twin pregnancies obtained with in vitro fertilization, on the contrary, were similar for all outcome measures, except for the incidence of cesarean delivery (odds ratio, 1.4; 95% confidence interval, 1.2-1.7) compared with spontaneously conceived twin pregnancies. Conclusion: The perinatal outcome of singleton pregnancies obtained with in vitro fertilization is significantly worse than that of spontaneously conceived pregnancies, mainly because of the increased rate of preterm birth. The outcome of twin pregnancies obtained with in vitro fertilization is comparable with that of normally conceived twins. For both singleton and twin pregnancies obtained with in vitro fertilization, the incidence of cesarean delivery is increased. (Am J Obstet Gynecol 1999;181:688-95.)

Cord blood thyrotrophin and foetal presentation at delivery in singleton pregnancies.

Cord blood thyrotrophin (TSH) levels of 134 patients with singleton pregnancies and breech presentation at delivery were compared with those of cephalic-presenting controls matched for mode of delivery, the presence of labour, parity, and the date of delivery. Infants delivered by vaginal breech delivery were found to have a higher incidence of elevated cord blood TSH level than either cephalic-presenting infants or breech-presenting infants delivered by Caesarean section. We conclude that vaginal breech delivery can be associated with false positive congenital hypothyroidism screening.

Intraamniotic infection in patients with preterm labor and twin pregnancies.

Microbial invasion of the amniotic cavity plays a major role in the pathogenesis of preterm labor and delivery in singleton pregnancy. Nevertheless, this association is not well established among patients with multiple gestations. The purpose of our study was to explore the role of intraamniotic infection in the setting of twin pregnancies. Consecutive women with twin gestations, intact membranes and preterm labor who underwent transabdominal amniocentesis under sonographic guidance. Amniotic fluid (AF) was retrieved from both sacs and cultured for aerobic and anaerobic microorganisms as well as for Mycoplasma species. Intraamniotic infection was defined as a positive AF culture for microorganisms. Mann Whitney U test or Student t-test or Fisher's exact test were utilized for analysis. Amniotic fluid was obtained from 74 patients. Sixty-eight women delivered prematurely (91.9%). Amniotic fluid culture results were positive for microorganisms in nine cases and all women with intraamniotic infection delivered prematurely as well as 59 (90.7%) patients with negative culture. Among the nine patients with intraamniotic infection, microorganisms were isolated from the presenting sac in five cases (55.6%), from both sacs in three patients (33.3%) and from the upper sac in the remaining case (11.1%). Patients with a positive AF culture had a more advanced cervical dilatation, a shorter interval amniocentesis-to-delivery and a higher incidence of clinical chorioamnionitis than those with a negative AF culture. The prevalence of intraamniotic infection and clinical and histological chorioamnionitis in twin pregnancies and preterm labor is similar to singleton pregnancies and preterm labor. Therefore, women with multiple gestations and preterm labor should be managed as singleton pregnancies.

Maternal serum alpha-fetoprotein and birth weight in twin pregnancies.

In 102 twin pregnancies the mean birth weight of each pair showed a statistically significant negative association with maternal serum alpha-fetoprotein (AFP) levels early in pregnancy. Women with AFP levels of four or more times the median value for singleton pregnancies gave birth to infants with a median birth weight 660 g less than that of infants born to women with AFP levels between 1.0 and 1.5 times the median for singleton pregnancies. Maternal serum AFP has been shown to be an early predictor of low birth weight delivery in singleton pregnancies. Our results indicate that this is also true in twin pregnancies.