Differences In Perinatal Outcomes Research Articles

Optimal Timing of Delivery in Women with Higher Order Cesareans: A Cohort Study.

To evaluate whether a planned early term delivery or a planned 39-week delivery is associated with differences in perinatal outcomes in women undergoing a higher order cesarean (HOC). This cohort study included women with singleton gestations with a history of three or more prior cesareans who delivered at one of two urban tertiary care hospitals. One center routinely delivered HOC at 39 weeks' gestation and the other at 37 weeks. Maternal and neonatal morbidities were compared using bivariable and multivariable analyses. The policy of 37-week delivery was associated with a decrease in unscheduled deliveries (15.3 vs. 41.1%; p < 0.001). Planned delivery at 37 weeks was associated with a decreased incidence of composite maternal morbidity (1.6 vs. 7.9%; p = 0.002) and 5-minute Apgar score less than 7 (0.4 vs. 6.4%; p < 0.001), but these differences were not significant after controlling for potential confounders (adjusted odds ratio [aOR]: 0.30, 95% confidence interval [CI]: 0.08-1.17; aOR: 0.13, 95% CI: 0.01-1.30, respectively). There were no other differences in perinatal outcomes. Compared with planned delivery at 39 weeks, a policy of planned delivery at 37 weeks was associated with a reduction in unscheduled deliveries, but there were no measured differences in perinatal outcomes.

Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis

ObjectiveTo evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria.DesignRetrospective cohort study.SettingLevel-three...

The impact of thyroid-stimulating hormone levels in euthyroid women on intrauterine insemination outcome

BackgroundThe aim of this study was to examine the effect of thyroid-stimulating hormone (TSH) levels on intrauterine insemination (IUI) outcomes among euthyroid women.MethodsA retrospective cohort study was conducted. A total of 302 women who started their first IUI cycle in our fertility center were included in this study. The patients were categorized into two groups based on their preconception TSH values: 0.38–2.49 mIU/Land 2.50–4.99 mIU/L. The clinical pregnancy rate was the main outcome parameter. As secondary parameters, we evaluated the differences in spontaneous abortion rate, live-birth delivery rate, and perinatal outcomes according to the preconception TSH threshold (< 2.5 and < 5.00 mIU/L).ResultsThere was no significant difference between the two groups with respect to clinical pregnancy, miscarriage, and live-birth rates with an odds ratio of 1.67 (95% CI: 0.79–3.53), 1.08 (95% CI: 0.09–13.1), and 1.79 (95% CI: 0.77–4.2), respectively. In addition, there were no significant differences in perinatal outcomes (gestation at delivery, birth weight, and neonatal intensive care unit–administration rate) between the two groups.ConclusionsOur findings indicate that among euthyroid patients, preconception TSH values in the high-normal range (between 2.5 and 4.9 mIU/L) do not have a negative effect on IUI outcomes.Trial registrationThis study is retrospectively registered by Ethical Review Board at Inonu University in 19th December 2017; Ethics approval no is 2017–27-20.

588: Validation of the admission prediction model for vaginal birth after cesarean delivery

To externally validate the admission prediction model for successful vaginal birth after cesarean (VBAC) using an ethnically diverse population. We have previously published a comparison between predicted and actual success rates using the prenatal intake calculator of the Maternal-Fetal Medicine Units Network prediction model (MFMU). Retrospective cohort study analyzing all women with at least one prior cesarean delivery attempting a trial of labor between 2007-2016 at a tertiary medical center. We investigate the difference between predicted and actual success rates using MFMU VBAC predictor model with variables collected upon admission. Participants were stratified into three probability-of-success groups: low (<35%), moderate (35-65%) and high (>65%). The primary outcome was the difference between predicted and actual success rates. Secondary outcomes include differences in intrapartum variables and perinatal outcomes between the three groups. P values were calculated with ANOVA, paired t-test, chi-squared test, or Fisher's exact test as appropriate. All analyses were done with STATA 14.2 614 women met the inclusion criteria. Actual VBAC rates did not differ from predicted rates when predicted chance of success was less than 65%, in either low (28.5% vs. 25.8%, p=0.79) or moderate groups (55.8% vs. 52.1%, p=0.37). However, in the high probability group, actual success rates were lower than predicted success rates (79.2% vs. 83.5%, p=0.02). Women in the higher probability groups were less likely to need augmentation of labor (76.2% vs. 74.3% vs. 40.9%, p<0.001), less likely to have diabetes (28.6% vs. 13.2% vs. 7.4%, p=0.001), more likely to have a midwife as primary provider (14.3% vs. 18.4% vs. 30.4, p=0.009), less likely to have elevated blood pressure (47.6% vs. 15.4% vs. 7.0%, p<0.001) during labor and less likely to need magnesium sulfate treatment (19.1% vs. 9.6% vs. 3.5%, p<0.001). There was no statistically significant difference in perinatal outcomes between the three groups. The published prediction model incorporating admission variables is predictive of VBAC success rates, but may slightly overestimate actual success rates in those with predicted success rates >65%. This model was more predictive of VBAC success than the prenatal intake admission calculator in our cohort.

924: Prevalence of gestational diabetes after implementation of International Association of Diabetes in Pregnancy Study Group (IADPSG) screening guidelines

We sought to examine the impact on prevalence of gestational diabetes (GDM) diagnosis by adoption of international association of diabetes in pregnancy study group (IADPSG) screening guidelines. We conducted a retrospective cohort study using a natural experiment model that compared two time frames between 2009 and 2013 at a single institution. We introduced IADPSG GDM screening guidelines in 2012 and sustained that screening practice over time. Date of delivery was dichotomized by those delivering before November 1st, 2012, and those delivering after. In a population of 6,424 women with singleton, vertex, term gestations, we examined the prevalence of GDM by date of delivery and results were stratified by parity, maternal age, and BMI. Chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. Our multivariate logistic regression model controlled for diabetes mellitus, hypertension, parity, maternal age, BMI and race/ethnicity. Overall, we found that the rate of GDM increased significantly pre- and post change in screening protocol in all women (8.3% vs. 11.8%, p<.001) and when stratified by parity, maternal age, and BMI (p<.05 for all). The most dramatic increases in GDM prevalence occurred in lower-risk groups, such as nulliparous women (odds ratio [OR] 2.09; 95% confidence interval [CI], 1.49-2.94), women less than 35 years old (OR 1.80; 95%CI, 1.39-2.33) and normal weight women (OR 2.27; 95%CI, 1.52-3.39). Implementation of the IADPSG GDM screening guidelines significantly increased GDM prevalence overall and in all analytic sub-groups. Future research should focus on the differences in perinatal outcomes in different screening cohorts.

Comparison of Amniotic Fluid Index and Single Deepest Vertical Pool method for predicting fetal outcome

Background &amp; Objectives: The measurement of amniotic fluid volume (AFV) has been an important component of antenatal evaluation of fetal well being. The most commonly used methods are by amniotic fluid index technique (AFI) and single deepest pool method (SDVP). Both the methods employ ultrasound for AFV measurement. The objective of this study is to compare the usefulness of AFI and SDVP method in assessing amniotic fluid volume for predicting adverse perinatal outcome.Materials &amp; Methods: This is a hospital based prospective comparative study. The patient whose amniotic fluid was measured by SDVP technique was study group and that by AFI was comparison group. Any case with high risk factor was excluded from the study. First case was decided by lottery and then alternately one case was kept in study group and the other in comparative group. If the women did not deliver within 1 week the measurements was retaken and the final values was used for analysis.AFI was estimated as described by Phelan and colleagues and SDVP as described by Manning. Data collection was started after the approval of Institution review board. This study was conducted at Patan Academy of Health Sciences. Duration of data collection was 3 months, Asadh –Bhadra, 2071.Results: A total of one hundred and fifty four cases which met the inclusion criteria were taken. Incidence of oligohydramnios by SDVP method was 10.4 % by SDVP technique and by AFI method it was 18.2 %. There was no statistical significant difference between the two groups in terms of rate of induction, mode of delivery, meconium staining of liquor, fetal heart rate tracings, APGAR score at 5 mins and admission to special care baby unit.Conclusion: In non-high risk pregnancy AFI technique detects slightly more number of oligohydramnios as compared to SDVP technique without apparently any difference in perinatal outcome.

A COMPARATIVE STUDY BETWEEN THE EFFICACY OF NIFEDIPINE AND HYDRALAZINE IN SEVER PREECLAMPSIA IN THE THIRD TRIMESTER OF PREGNANCY AND COMPARISON THE PERINATAL OUTCOME IN SULAIMANI MATERNITY TEACHING HOSPITAL

Background Preeclampsia is an idiopathic disorder of pregnancy characterized by proteinuric hypertension; hydralazine is an arterial vasodilator antihypertensive drug. Nifedipine is a calcium channel blocker antihypertensive drug. Objective To compare the effect of intravenous hydralazine and oral immediate release nifedipine capsule in patients with severe preeclampsia in their 3rd trimester of pregnancy and compare the early perinatal outcome. Material and Methods A prospective cohort study set at Sulaimani Maternity Teaching Hospital, Sulaimani, Iraq, throughout period of January first 2015 to September first 2015. The study includes 50 patients diagnosed with sever preeclampsia (blood pressure ≥ 160/110 mmHg and &gt; 1 gram proteinuria) in the third trimester of pregnancy, who admitted to Emergency Department of Sulaimani Maternity Teaching Hospital from January, first 2015 to September, first 2015. Patients had been divided into two groups, the first 25 patients had received hydralazine and the second 25 patients received nifedipine. The blood pressure and fetal heart rate recorded before and after the treatment, the target blood pressure: Systolic blood pressure &lt; 160 mmHg and diastolic blood pressure &lt; 110 mmHg. Results Both drugs were ultimately effective in reaching the therapeutic goal because there were no failures requiring crossover in either study group. Patients received intravenous hydralazine achieved the therapeutic blood pressure more rapidly in (38.0±14.0) minutes (mean±SD) as compared with (51.3±23.9) minutes who received oral immediate release nifedipine. P=0.05. Both drugs had no effect on fetal heart rate but they had many maternal side effects especially with hydralazine which associated with more palpitation than nifedipine (12% versus 8%). In mode of delivery, 72% of women from hydralazine group and 52% of women from nifedipine group their pregnancies are terminated by caesarean section, while 36% of women from nifedipine group and 20% of women from hydralazine group were delivered vaginally. Conclusion Both drugs are efficient in controlling the blood pressure in sever preeclampsia and no significant difference in perinatal outcome. Nifedipine needed longer period but less number of doses to reach the goal blood pressure. Because the nifedipine’s oral bioavailability and less frequent side effects, it more preferable anti-hypertensive therapy in emergency cases compared to the hydralazine.

Do poor responders have poor perinatal outcomes? A retrospective analysis of 1386 assisted reproductive technology cycles

Abstract Objective The purpose of this study was to evaluate whether poor responder women have adverse perinatal outcomes compared to normo responders following assisted reproductive technology (ART). Methods A retrospective cohort study was conducted in a university level infertility unit between January 2010 to December 2015. Women undergoing fresh IVF cycles were included. Poor responders (≤3 oocytes) and normo responders (4–15 oocytes) were analyzed. Perinatal outcomes such as preterm birth (PTB), low birth weight (LBW), early preterm birth (early PTB) and very low birth weight (very LBW) were recorded. Results A total of 1386 ART cycles were analyzed. Final analysis included 40 and 318 live births in poor and normo responders respectively. The risk of PTB (30.3% vs. 24.8%; OR 1.32, 95% CI: 0.59–2.9), LBW (33.3% vs. 20.1%; OR 1.99, 95% CI 0.90–4.4), early PTB (3% vs. 2.2%; OR 1.40, 95% CI 0.16–12.4) and very LBW (3% vs. 1.8%: OR 1.72, 95% CI 0.19–15.9) were not significantly different between poor and normo responders. The subgroup analysis within poor responders did not show any significant difference in perinatal outcomes in women aged less and more than 35 years. Conclusion The current study findings suggest no increased risk of adverse perinatal outcomes in poor responders compared to normo responders following ART. These findings need to be further validated by larger studies.

Perinatal outcomes in autologous versus donor egg recipient (DER) cycles in older patients: analysis of 156,873 cycles reported to SART cors

Studies have demonstrated worse perinatal outcomes in DER cycles vs. autologous embryo transfers, but these studies are confounded by differences in age, controlled ovarian hyperstimulation (COH) protocols and fresh vs. frozen embryo transfers1,2. As a result, different endometrial conditions were not controlled for. We sought to evaluate differences in perinatal outcomes between older patients with similar endometrial conditions at the time of frozen thawed embryo transfer.

OP21.05: The cerebroplacental ratio as a prognostic factor of fetal outcome in pregnancies complicated by maternal sickle cell disease

Sickle cell disease (SCD) in pregnancy can have adverse effects on both maternal and fetal circulations. These circulations can be assessed using Doppler ultrasound of the middle cerebral and umbilical arteries. The cerebroplacental ratio (CPR), a ratio of the middle cerebral and umbilical artery indices, is emerging as an important predictor of adverse pregnancy outcomes. This has implications for assessing well-being in fetuses diagnosed as small for gestational age, a common finding in SCD patients. The aim of this study was to assess the role of CPR in predicting adverse fetal outcomes in patients with sickle cell disease. A prospective cohort study was conducted at Korle Bu Teaching Hospital, Ghana over a six-month period. SCD patients at 34 weeks gestation or more were recruited to undergo weekly Doppler assessment until delivery. The CPR was calculated and participants were categorised into two study arms based on a CPR<1.1 or >1.1. Adverse perinatal outcomes including IUGR, stillbirth, low birth weight and NICU admissions were compared between the two groups. There were five fetuses with CPR<1.1 and 25 adverse perinatal events: 2 stillbirths, 10 low birth weight neonates, 12 NICU admissions and 1 APGAR score below 7 at 5 minutes. A CPR<1.1 had positive and negative predictive values of 100% and 72% respectively for predicting composite adverse perinatal outcomes. The sensitivity and specificity for predicting stillbirths were 100% and 93% respectively and 40% and 97% respectively for low birth weight. There was no significant difference in perinatal outcomes between the two major sickle cell genotypes (SS and SC). Mothers in the CPR< 1.1 group were also more likely to have severe anemia, blood transfusions and acute malaria during their pregnancy. A CPR <1.1 was shown to be significantly associated with adverse perinatal outcome especially low birthweight (<2.5kg) and antenatal stillbirths in fetuses of women with sickle cell disease.

Perinatal outcomes after induced termination of pregnancy by methods: A nationwide register-based study of first births in Finland 1996–2013

BackgroundWomen with previous terminations of pregnancy (TOPs) before their first birth have been associated with poorer perinatal outcomes. However, previous studies on the perinatal outcomes by the method in previous TOPs are inconsistent.ObjectiveTo examine the perinatal outcomes of the first-time mothers with singleton births, by the method of previous TOP (medical and surgical vs no TOP, and surgical vs medical).MethodThis is a nationwide register-based study including 419,879 first-time Finnish mothers with singleton birth during the time period 1996–2013. Mothers having their first birth were identified from the Medical Birth Register and linked to the Abortion Register by their identification numbers. Multinomial logistic regression analysis was performed to examine the risk for preterm birth, low birth weight, small for gestational age and perinatal death by the method in previous TOPs.ResultsAmong the first-time mothers, 87.0% had no history of TOPs, 3.2% had a history of medical TOP(s), 9.2% had a history of surgical TOP(s) and 0.6% had a history of both (medical and surgical) TOP(s). No significant differences in perinatal outcomes were found among the women with surgical TOPs, compared to the women with no TOPs. In unadjusted analysis, increased odds for preterm birth and low birth weight were found when comparing women having previous surgical TOPs with medical TOPs. Even after the adjustment of potential confounders, odds for preterm birth < 37 weeks (OR = 1.19, 95% CI = 1.04–1.36) and low birth weight < 2500 g (OR = 1.16, 95% CI = 1.00–1.35) remained significant. After restricting data to the single TOP, the results were similar; OR for both preterm birth and low birth weight was 1.18 (95% CIs = 1.02–1.36 and 1.01–1.38).ConclusionPerinatal outcomes did not differ among the mothers with surgical TOPs compared to the mothers with no TOPs, while the outcomes were poorer after surgical TOP(s) than after medical TOP(s).

Comparison of Two Screening Strategies for Gestational Diabetes (GDM2) Trial: Design and rationale

Gestational diabetes mellitus (GDM) affects approximately 5 to 7% of pregnancies and is associated with increased risk for fetal overgrowth, cesarean delivery, birth trauma, and pre-eclampsia. GDM is commonly diagnosed in the US using a two-step screening and confirmatory approach, whereas a one-step approach is commonly used outside the US. Recent guidelines have suggested that the one-step approach should be used to diagnose GDM, although concern that this may increase the prevalence of GDM to approximately 18%—as well as the lack of clinical trials-based evidence regarding the difference in perinatal outcomes–has led to skepticism about adopting the one-step approach. The Comparison of Two Screening Strategies for Gestational Diabetes (GDM2) Trial is a single-center, parallel-arm, comparative effectiveness trial of one-step versus two-step GDM screening strategies on the rate of adverse perinatal outcomes including: large-for-gestational age (LGA) deliveries (primary outcome), small-for-gestational age (SGA), macrosomia, cesarean delivery, fetal growth and body composition, and maternal and neonatal composite outcomes. This paper describes the design and analysis plan of the GDM2 Trial as well as overall challenges in assessing the impact of screening and diagnosis strategy on adverse pregnancy outcomes. We will also assess whether the additional women diagnosed with the one-step approach benefit from treatment as assessed by metabolic profiles at one year postpartum. Ultimately, this study will provide the necessary evidence for establishing universal guidelines for GDM diagnosis and implementation into clinical care.

Fresh and Frozen-Thawed Embryo Transfer Compared to Natural Conception: Differences in Perinatal Outcome

Background/Aim: To compare the pregnancy outcome of singletons conceived after transfer of cryopreserved and thawed embryos (frozen embryo transfer [FET]) to singletons conceived after fresh embryo transfer (fresh ET) and natural conceived singletons. Methods: Using a retrospective data analysis on a study population consisting of 1,261 singletons born after FET and 2,519 singletons born after fresh ET between 2006 and 2015. The control group consisted of singletons born after natural conception. Main outcome measures consisted of birth weight (in grams), gestational age, preterm birth (<37 weeks of gestation), being large for gestational age (LGA, above 90th weight percentile adjusted for gestational age) and Apgar scores. Results: Babies born after FET had an increased risk of high birth weight (adjusted OR [AOR]) 2.92; 1.503-3.482) and being LGA (AOR fresh ET vs. FET 1.47; 1.210-1.787) compared to singletons born after fresh ET, as well as higher birth weights compared to natural conceived children. Conclusions: Singletons born after FET have a higher risk of high birth weight and being LGA compared to singletons after fresh ET and compared to natural conceived singletons. We assume that the freezing process might be the underlying cause.

Decision-to-Delivery Time Intervals in Emergency Caesarean Section Cases: Repeated cross-sectional study from Oman.

In cases of fetal intolerance to labour, meeting the standard decision-to-delivery time interval (DDI) of ≤30 minutes is challenging. This study aimed to assess DDIs in emergency Caesarean section (CS) cases to identify factors causing DDI delays and the impact of a delayed DDI on perinatal outcomes. This repeated cross-sectional study included all emergency CS procedures performed due to acute fetal distress, antepartum haemorrhage or umbilical cord prolapse at the Nizwa Hospital, Nizwa, Oman. Three audit cycles of three months each were conducted between April 2011 and June 2013, including an initial retrospective cycle and two prospective cycles following the implementation of improvement strategies to address factors causing DDI delays. Poor perinatal outcomes were defined as Apgar scores of <7 at five minutes, admission to the Special Care Baby Unit (SCBU) or a stillbirth. In the initial cycle, a DDI of ≤30 minutes was achieved in 23.8% of 84 cases in comparison to 44.6% of 83 cases in the second cycle. In the third cycle, 60.8% of 79 women had a DDI of ≤30 minutes (P <0.001). No significant differences in perinatal outcomes for cases with a DDI of ≤30 minutes versus 31-60 minutes were observed; however, a DDI of >60 minutes was significantly associated with poor neonatal outcomes in terms of increased SCBU admissions and low Apgar scores (P <0.001 each). Factors causing DDI delays included obtaining consent for the CS procedure, a lack of operating theatre availability and moving patients to the operating theatre. The identification of factors causing DDI delays may provide opportunities to improve perinatal outcomes.

Intrapartum intervention rates and perinatal outcomes following induction of labour after 41 + 0 weeks compared to expectant management

Objective: There is limited evidence regarding the incidence of intrapartum fetal compromise in women who are induced compared to those managed expectantly. The aim of this study was to investigate intrapartum and perinatal outcomes in women who were induced at >41 + 0 weeks compared to an expectantly managed cohort.Methods: This was a retrospective cohort study of singleton, non-anomalous pregnancies delivering between 41 + 0 to 43 + 0 weeks at the Mater Mothers’ Hospital, Brisbane. We compared outcomes between women who were induced and those that laboured spontaneously.Results: Six thousand five hundred and one women met the inclusion criteria. Three thousand five hundred and eighty-eight women (55.2%) underwent IOL and 2913 women (44.8%) were managed expectantly. Higher rates of emergency caesarean section (29.4% versus 18.5%, p < 0.001) and higher rates of instrumental birth (20.2% versus 17.7%, p = 0.012) were found in the IOL cohort. The odds of requiring an emergency CS for non-reassuring fetal status was increased (OR 1.51, 95% CI 1.21–1.90). Other than a high proportion of neonatal acidosis in the IOL cohort, there were no differences in perinatal outcomes between the two groups.Conclusion: IOL > 41 weeks compared to expectant management results in higher rates of emergency caesarean section mainly due to intrapartum fetal compromise.

Clinical significance of fasting plasma glucose in patients with normal 50-g glucose challenge test in pregnancy: Is 100 bigger than 92?

abstractThe present study aimed to analyse the perinatal outcomes in patients with normal 50-g Glucose Challenge Test but who are considered retrospectively to have gestational diabetes mellitus based on elevated fasting plasma glucose (FPG) levels according to recent criteria. The study was conducted between January 2010 and December 2014 to identify patients with FPG values >92 mg/dl and GCT values <130 mg/dl. The patients were divided into two groups: those with FPG values between 92 and 99 mg/dl (Group 1) and those with FPG values >99 mg/dl (Group 2). The rate of obstetric complications was similar in the three groups, except for a higher rate of preeclampsia in Group 2 than in the control group (8.3% versus 3.1%; p = 0.031). The rate of large for gestational age neonates in Group 2 was 15%, which was higher than the rate in Group 1 (5.5%) and control group (7.4%) (p = 0.046 and p = 0.047, respectively). The rate of neonatal intensive care unit admissions in Group 2 was 11.7%, which was higher than the rate in Group 1 (3.1%) and in the control group (2.4%). Our findings indicate that there is a clinically recognisable difference in perinatal outcomes when a threshold of 100 mg/dl is used for FPG instead of 92 mg/dl.

Maternal and perinatal outcomes in women with and without hypertensive syndromes submitted to induction of labor with misoprostol

ABSTRACTObjectives: To determine maternal and perinatal outcomes according to the mode of delivery in normotensive and hypertensive women bearing a live, full-term fetus, who were submitted to labor induction with misoprostol. Methods: Retrospective cohort study. The endpoints were tachysystole, uterine hyperstimulation, indications for cesarean section, severe maternal morbidity, side effects, maternal death, 1st/5th minute Apgar, neonatal death, requirement for neonatal intensive care, and birth weight (grams). The chi-square or Fisher’s exact test was applied at a significance level of 5%. Risk ratios (RRs) and their 95% confidence intervals (95% CI) were calculated. Results: No significant differences were found in maternal outcome as a function of mode of delivery. First-minute Apgar score <7 was less common with vaginal deliveries in normotensive women (RR = 0.41; 95% CI: 0.18–0.90), this being the only significant difference in perinatal outcome. Conclusion: Maternal and perinatal outcomes were similar in hypertensive and normotensive women submitted to labor induction with misoprostol.

Comparison of perinatal outcomes following fresh and frozen-thawed blastocyst transfer

ObjectiveTo investigate the effect of ovarian stimulation on endometrial receptivity by comparing singleton pregnancy and perinatal outcomes following fresh or frozen-thawed blastocyst transfers. MethodsA retrospective cohort study enrolled patients undergoing fresh or frozen-thawed blastocyst transfers that resulted in live deliveries between January 1, 2010 and September 30, 2013 at a single academic center. Implantation, clinical pregnancy, spontaneous abortion, and live delivery rates were calculated. The incidence of term delivery, preterm delivery, low birth weight, term low birth weight, and very low birth weight were also recorded. To detect a 10% difference in the implantation rate, a minimum sample size of at least 415 transfer cycles in each group was estimated. ResultsThe study included data from 918 fresh and 1273 frozen-thawed cycles. Patients in both groups were of similar age and there was no difference in the grading of blastocysts. No differences were observed in the implantation (37.3% vs 37.7%), clinical pregnancy (50.2% vs 49.4%), spontaneous abortion (7.3% vs 9.3%), and live delivery (42.9% vs 40.6%) rates of the two groups. A sub-analysis of all live singleton and twin deliveries revealed no difference in perinatal outcomes between the two techniques. ConclusionsThe present study demonstrated equivalent singleton pregnancy and perinatal outcomes when comparing frozen-thawed and fresh blastocyst transfer procedures.

Dizygotic twin pregnancies after medically assisted reproduction and after natural conception: maternal and perinatal outcomes

To compare maternal and perinatal outcomes in dizygotic twin pregnancies conceived after medically assisted reproduction (MAR) with outcomes after natural conception (NC). Nationwide registry based study. Academic medical center. Primiparous women who delivered opposite sex twins between January 2000 and December 2012 in the Netherlands, comprising dizygotic twin pregnancies: 6,694 women, 470 after ovulation induction (OI), 511 after intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH), 2,437 after invitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), and 3,276 after NC. None. Multivariable logistic regression and generalized linear mixed models to evaluate differences in outcomes: maternal outcomes of hypertension, preeclampsia, preterm delivery, hemorrhage, and delivery mode, perinatal outcomes including small for gestational age (SGA) with birth weight <10th percentile, birth weight <1,500g, 5-minute Apgar score <7, admission to neonatal intensive care unit, congenital anomalies, and perinatal mortality. We found no statistically significant differences in maternal or perinatal outcomes after OI compared with NC. Women pregnant after IVF-ICSI had a lower risk for hypertension (adjusted odds ratio [aOR] 0.74; 95% confidence interval [CI], 0.66-0.83) compared with women pregnant after NC. After IUI-COH more children had Apgar scores <7 (adjusted odds ratio (aOR) 1.38; 95% confidence interval (CI) 1.05-1.81) and perinatal mortality rates were higher (aOR 1.56; 95% CI, 1.04-2.33) compared with NC. We found no differences in perinatal outcomes after IVF-ICSI compared with NC. Overall, maternal and perinatal risks other than those due to multiplicity are similar for twin pregnancies conceived after MAR and after NC.

Perinatal outcomes after adopting 1- versus 2-step approach to diagnosing gestational diabetes

Objective: The American College of Obstetricians and Gynecologists (ACOG) and the IADPSG (International Association of Diabetes and Pregnancy Study Groups) proposed distinct approaches to diagnosing gestational diabetes mellitus (GDM). We sought to analyze these paradigms: (1) ACOG 2-step approach where screening is followed by diagnostic testing, (2) IADPSG 1-step diagnostic testing.Study design: We reviewed data from pregnant women (24–28 wks) screened for GDM over two periods: (1) November 2011–May 2012 (2) November 2012–May 2013. Period 1: 2-step approach (screening 1-h glucose challenge test (GCT) followed by a diagnostic 3-h 100-g glucose tolerance test (GTT) when abnormal (≥140 mg/dl)). Period 2: an abnormal value after a 2-h 75-g GTT result was diagnostic of GDM. We compared the incidence of GDM and perinatal outcomes using either approach.Results: Out of 471 patients screened by ACOG 2-step approach, 72 (15.3%) had an abnormal 1-h screening and underwent the 3-h diagnostic GTT, and 26 (5.5%) developed GDM. The 1-step approach resulted in 53 (15.96%) with GDM of a total 332 evaluated. There was no statistically significant difference in perinatal outcomes between the two cohorts. Maternal weight at the start and the end of pregnancy was greater for patients diagnosed by the ACOG 2-step approach.Conclusion: Adopting 1-step approach (ADA) to diagnose GDM resulted in a 3-fold increase in prevalence of GDM with no differences in perinatal outcomes.