Incidence Of Twin Pregnancies Research Articles

The Effectiveness of Routine Cerclage in In Vitro Fertilization (IVF) Twins.

The incidence of twin pregnancies is on the rise worldwide due to assisted reproductive technologies. Cervical dilatation is a frequent complication and can be considered a cause of premature births in twin pregnancies. In vitro fertilization (IVF) twins are more prone to preterm delivery. Routine cervical cerclage with normal cervical length is not recommended in twins, but studies were not done on IVF twins. So, this study aims to evaluate the effectiveness of routine transvaginal cerclage in twin IVF pregnancies with normal cervical length on maternofetal outcome. A retrospective case-control study was conducted at a maternity hospital in eastern Indiafrom January 2016 to December 2019 with over 21800 deliveries. Two groups were taken, cases were those IVF twins with normal cervical length in whom cervical cerclage was done as they have referred to our hospital from the IVF centers for cerclage and in control no-cervical cerclage as they are referred from other IVF centers where cerclage was not a routine protocol. We have excluded cerclage done for history, ultrasound indicated, uterine anomalies, and monochorionic twins. Fifteen participants were recruited in both cases and controls. In our study 2 (6.66%), 4 (13%), and 26 (86%) were IVF twins delivered at a gestational age of <28 weeks, 28-32 weeks, and 32-37 weeks, respectively. The mean age of participants, mean gestation age at delivery, and birth weight in cases and control were 35.27 ± 5.98 years (min: 23; max: 45), 32.40 ± 5.54 years (min: 25; max: 44); 34 weeks 2 days ± 3.28 (min: 31; max: 37), 33 weeks 5days ± 1.66 (min: 25; max: 37); 1961.33 ± 340 gram, 1899.33 ± 437.48 gram, respectively with no statistical significant difference (p = 0.186, p = 1, p = 0.668, respectively) Conclusion: Routine transvaginal cerclage is not effective in twin IVF pregnancies with normal cervical length for preventing preterm births. IVF twin women usually present at a late age and their birth weight are also low.

Evidence-based Management of Multiple Gestation

Objective: The goal of this review is to provide a succinct, yet comprehensive, guide to the antepartum management of multiple gestations. Methods: This narrative review on twins and multiple gestation provides a concise guide for providers with this ever-growing patient population. PubMED was utilized for literature search. Each reference was evaluated and graded for quality of evidence by US Preventative Services Task Force and Cochrane Review guidelines. Screening, surveillance, and management strategies are delineated succinctly and organized by type of multiple gestation being managed from the lowest risk dichorionic twin pair to the increasingly escalating risks of twins and higher order multiples sharing a placenta and/or amniotic sac. Results: The incidence of twin pregnancies has grown over the past several years, due in large part to delayed reproductive timing and surge in assisted reproductive technologies. Twin pregnancies are associated with higher morbidity for both gravidas and offspring, warranting evidence-based approach in counseling and management. Conclusions: We note the important differences among multiples in chorionicity and amnionicity, in the importance of close surveillance and early delivery. Graded clinical pearls and evidence-based recommendations are presented to guide obstetric providers.

#57 : A Prediction Model of Low Birthweight in Singleton Pregnancies Reduced from Dichorionic Twin Pregnancies

Background and Aims: The incidence of twin pregnancies has risen over the last few decades, mainly attributed to assisted reproduction techniques (ART). Fetal reduction (FR) can significantly reduce low birthweight (LBW) risk in twins. However, the LBW risk is still higher in singletons reduced from twins than for primary singletons. Many factors, such as maternal factors, FR timing and approach may affect LBW risks after FR and no relevant prediction models have been reported to date. The main objective of this study is to develop a nomogram to predict LBW risk in singleton pregnancies reduced from dichorionic (DC) twins. Method: We retrospectively reviewed and analyzed the data on women with (DC) twin pregnancies who underwent FR in Women’s Hospital, Zhejiang university, School of medicine in July 2005 to August 2021. Logistic LASSO regression was used to identify the most relevant variables associated with LBW. The nomogram was constructed and receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and decision clinical analysis were used for model performances assessment and visualization. The model was evaluated by cohorts produced by 500 resampling bootstrap analysis to testify the stability. Results: A total of 471 patients were enrolled in the analysis. At last, seven independent predictive factors for LBW were identified and integrated to construct the nomograms, including maternal height, nulliparous, conception mode, reasons for FR, gestational age at FR, gestational diabetes, pregnancy hypertensive disease. The AUC of our prediction model was 0.793, which was validated by internal (AUC 0.762) confirmation with bootstrap analysis. The nomogram had well-fitted calibration curves. Decision curve analysis demonstrated that the nomogram was clinically useful. Conclusion: We made the first attempt to develop a reliable predictive nomogram for the risk of LBW in DC twin pregnancies reduced to singletons, providing a useful guide for clinicians and patients in making appropriate FR decisions.

Incidence and Perinatal Outcomes of Twin Pregnancy in Tertiary Healthcare Facility, Odisha, India

Background: Assisted reproductive technology has resulted in a progressive rise in the incidence of twin pregnancies, which affect both mother and child in terms of antepartum complications. Objective: To assess the perinatal outcomes of twin pregnancies and the influence of chorionicity on them in a tertiary healthcare facility. Methods: It is a hospital-based cross-sectional study that was carried out in the Obstetrics and Gynecology Department of S.C.B. Medical College Hospital, Cuttack, during the period from 2013 to 2015. All mothers having twin pregnancies (with 28 weeks of completed gestation) admitted to the antenatal (ANC) ward and labor room during this period were taken as a study group, and written informed consent was taken after explaining the details of the study. Results: A total of 150 cases are identified; among them, 98 cases (65.33%) are dichorionic diamniotic, 50 cases (33.33%) are monochorionic diamniotic, and 2 cases (1.33%) are monochorionic and monoamniotic pregnancies. The majority (66%) of the twin pregnancies were between 35-38 wks of gestational age at the onset of labor. It is also observed that macerated births, stillbirths, and neonatal deaths are higher in mono-chorionic twins as compared to dichorionic twins. Conclusions: Twin pregnancies carry a greater risk of adverse outcomes, especially perinatal mortality and neonatal morbidity, in monochorionic twins than dichorionic twins. Good antenatal care, early diagnosis of chorionicity, and antepartum assessment of placentation will prevent mortality and morbidity.

Retrospective Study of the Correlation Between Twin Pregnancies and Perinatal Outcome in Association to the Impact of Preterm Birth.

Twin pregnancies make up 2% to 4% of all births. Incidence of spontaneous twin pregnancies varies around the world, with percentages ranging from 8/1000 to >17/1000 births. The variation in twin pregnancy rates is thought to be due to dizygotic pregnancies, since monozygotic pregnancies have a consistent incidence of 3.5/1000 to 4/1000 births. The incidence of twin pregnancies after the widespread use of assisted reproduction has increased significantly. The purpose of the present study is to investigate factors , who contribute to improve the perinatal outcome in twin pregnancies. Support will be provided by the results of twin pregnancies by the Department of Obstetrics and Gynaecology of Demokrition University of Thrace (Alexandroupolis, Greece) in the last fifteen years. From the above Department, data were collected on the number of twin pregnancies, maternal age, gestational age, mode of delivery (spontaneous delivery or caesarean section), birth weight and rate of twin pregnancies with assisted reproduction. The results showed the increasing trend of twin pregnancies and births. A total of 304 twin pregnancies were identified (rate 2.75%). The rate of assisted reproduction was 34.83% in our sample, while the rate of cesarean deliveries was 95.5%, showing a large increase in recent years. In ten cases, normal delivery was successfully performed. The gestational age in twin pregnancies that ended with normal delivery was 37.37 + 3 weeks and the fetuses were both cephalic presentations. The main reason for admission of newborns to the NICU Department was prematurity. The constantly improving education of perinatalists and understanding of the pathophysiology may lead to individualization of their treatment, and improvement of their prognosis based on recent scientific data from other international centers.

Analysis of twin pregnancy based on obstetrics and perinatal outcome in a tertiary care hospital in North-East India

Background and Objective: Over the last decade, the incidence of twin pregnancies has been enormously increased. Preterm births and neonatal deaths are associated with twin pregnancies which might be due to prematurity, fetal growth restriction and low birth weight. In the present study, the consequences of twin pregnancy have been analyzed. Methods: This descriptive observational study has been conducted in Silchar Medical College and Hospital in between June 1st 2020 to May 31st 2021.A total of 120 twin pregnant women admitted in maternity ward in labour during the study period. Maternal and perinatal outcome has been analyzed. Result: The result showed that pregnancy complications were remarkably higher. Preterm labour 65.4%, hypertensive disorder of pregnancy 35.2%, premature rupture of membrane 30.2%, anaemia 44.1%, antepartum haemorrhage 7.5%, liquor abnormalities 11.6%, cesarean section 46.7%, postpartum haemorrhage 18.3%, gestational diabetes mellitus 5.8% are the complications encountered. About 10.1% of first twins and 17% of second twins were asphyxiated (APGAR score <7) at 5 minutes of birth. The perinatal mortality rate was 10.2% for first twin and 16.2% for second twin. Very low birth weight (<1500 g) were 18.3% of 1st twins and 24.2% of 2nd twins. Low birth weight (1500 to 2000g) 41.7% of 1st twins and 38.3% of 2nd twins. Presentations during delivery of twin babies were vertex-vertex 50.8%, vertex-non vertex in 29.1%, non-vertex 1st twins 19.8%. Conclusion: Institutional deliveries are essential in twin pregnancies because twin pregnancies are considered as high-risk pregnancies. Early diagnosis, adequate ante-natal, intra-natal and postnatal care are important to boost the outcome.

Retrospective Study of the Correlation Between Twin Pregnancies and Perinatal Outcome in Association to the Impact of Preterm Birth

Background: Twin pregnancies make up 2% to 4% of all births. Incidence of spontaneous twin pregnancies varies around the world, with percentages ranging from 8/1000 to &gt;17/1000 births. The variation in twin pregnancy rates is thought to be due to dizygotic pregnancies, since monozygotic pregnancies have a consistent incidence of 3.5/1000 to 4/1000 births. The incidence of twin pregnancies after the widespread use of assisted reproduction has increased significantly. Objective: The purpose of the present study is to investigate factors , who contribute to improve the perinatal outcome in twin pregnancies. Support will be provided by the results of twin pregnancies by the Department of Obstetrics and Gynaecology of Demokrition University of Thrace (Alexandroupolis, Greece) in the last fifteen years. Methods: From the above Department, data were collected on the number of twin pregnancies, maternal age, gestational age, mode of delivery (spontaneous delivery or caesarean section), birth weight and rate of twin pregnancies with assisted reproduction. Results: The results showed the increasing trend of twin pregnancies and births. A total of 304 twin pregnancies were identified (rate 2.75%). The rate of assisted reproduction was 34.83% in our sample, while the rate of cesarean deliveries was 95.5%, showing a large increase in recent years. In ten cases, normal delivery was successfully performed. The gestational age in twin pregnancies that ended with normal delivery was 37.37 + 3 weeks and the fetuses were both cephalic presentations. The main reason for admission of newborns to the NICU Department was prematurity. Conclusion: The constantly improving education of perinatalists and understanding of the pathophysiology may lead to individualization of their treatment, and improvement of their prognosis based on recent scientific data from other international centers.

Characteristics of the oral glucose tolerance test in women with different pre-pregnancy body mass index and the effect of gestational diabetes mellitus on twin pregnancy outcomes

ObjectiveThis study aimed to investigate the mid-pregnancy blood glucose levels of women with singleton or twin pregnancies. MethodThe relationship between blood glucose levels and Gestational Diabetes Mellitus (GDM) was studied in women with different pre-pregnancy Body Mass Index (BMI), and the effect of GDM on twin pregnancy outcomes was analyzed. Women with twin (n = 1,985) and singleton (n = 1,985) pregnancies were categorized into underweight (BMI < 18.5 kg/m2, n = 597), normal weight (BMI: 18.5–23.9 kg/m2, n = 2,575), and overweight/obese (BMI ≥ 24 kg/m2, n = 798) groups. ResultsThe incidence of GDM was 21.01% in women with twin pregnancies. Among the women with GDM in twin pregnancies, 38.37% had at least two abnormal blood glucose levels. The incidence of these parameters increased with preconception BMI, and the incidence of twin pregnancies was higher than that of singleton pregnancies (p < 0.001). In the normal weight and overweight/obese group, the oral glucose tolerance test glucose level and incidence of GDM were higher in women with twin than singleton pregnancies (p < 0.05). For twin pregnancies, the prevalence of selective fetal growth restriction was higher and anemia was lower in the GDM group than in the non-GDM group (all p < 0.05). ConclusionTherefore, a greater emphasis should be placed on BMI before conception, and well-controlled GDM does not increase adverse pregnancy outcomes for twin pregnancies.

True Nodes of the Umbilical Cords of a Mono-Amniotic Pregnancy

The incidence of twin pregnancies, has increased due to assisted reproductive technologies [1]. We note a doubling between 1970 and 2010 from less than 8‰ to nearly 16‰ of pregnancies (Pison et al., 2014; Pison et al., 2015) in developed countries [2] and 17‰ to 20‰ in sub-Saharan Africa. Monozygotic twins are the product of fertilization of a single egg by a single sperm, with the egg splitting into two within the first few days after fertilization. If the division takes place after the 8th day, the pregnancy is mono-chorionic mono-amniotic (less 1% of cases of monozygotic pregnancies) and represents 1 in 30,000 pregnancies. It is the development of two fetuses within the same amniotic sac, representing the rarest type of twin pregnancy (1% of monozygotic twin pregnancies) but being the one with the highest fetal and maternal morbidity. The main complication feared is coiling and knots of the umbilical cords responsible for abnormal heartbeat, fetal suffering and eventual fetal death. We report the case of in utero fetal death of twins from a mono choral mono amniotic pregnancy secondary to knots and coiling of the cord in order to discuss the diagnostic and therapeutic aspects.

P-781 Elective single cleavage-stage embryo transfer in IVF patients with suboptimal ovarian response is not detrimental to cumulative pregnancy and reduces multiple pregnancy rates

Abstract Study question To compare elective single embryo transfer (eSET) with double embryo transfer (DET) in patients with suboptimal response to ovarian stimulation in terms of pregnancy rates. Summary answer Elective single embryo transfer in patients with suboptimal response to ovarian stimulation is not detrimental to cumulative pregnancy and delivery rates. What is known already Even though higher-order pregnancies in in vitro fertilization (IVF) programs have dropped significantly in recent years, the incidence of twin pregnancies is currently not negligible. The greatest efforts to promote eSET have been made in the IVF population with a good prognosis but results obtained in this population can hardly be extrapolated to patients with lower chances of success, such as those with low oocyte yield. Although still under discussion, it has been suggested that in patients with poor or suboptimal response to ovarian stimulation, eSET could achieve acceptable cumulative live birth rates with negligible risk of twin pregnancy. Study design, size, duration A matched case-control pre and post intervention study including IVF patients with poor or sub-optimal response to ovarian stimulation (≤9 oocytes) receiving a double embryo transfer (2016-2018) or elective single embryo transfer (2018-2020). Matching was performed 1:1 for female age (±18 months), AMH ≥1.2 or &amp;lt; 1.2 ng/ml and number of previous cycles. A sample size of 215 patients per group was foreseen to obtain ±5% variability of the main outcome (clinical pregnancy rate per cycle). Participants/materials, setting, methods A strict policy regarding single embryo transfer was introduced in our clinic from September 2018 to reduce twin pregnancy rates independently from ovarian response or embryo quality. Couples undergoing standard IVF or ICSI with ≤9 oocytes and at least 2 viable embryos were divided in two groups and matched for main variables known for influencing results: pre-intervention with DET (controls) and post-intervention with eSET (cases). In both groups, cryopreserved supernumerary embryos were always transferred individually. Main results and the role of chance A total of 463 patients with at least 2 viable embryos undergoing fresh embryo transfer after the recovery of 2 to 9 oocytes were retrospectively evaluated and, according to matching criteria, 212 cases (eSET) and 212 matched controls (DET) were included for data analysis. The cumulative clinical pregnancy rate per cycle was the same in the two groups (26%, 95%CI: 20-32%) with a crude OR = 1.00 (95%CI: 0.65-1.54), p = 1.00 and a mean female age of 37.4 and 38.0 years, respectively. The mean number of mature oocytes was 4 ±2 in both groups. Live birth rate was similar in cases and controls (22% and 21%, respectively) while twin pregnancies were significantly reduced in women receiving single embryo transfer (18% versus 0%, p = 0.008). Women receiving eSET were more likely to undergo a subsequent frozen embryo transfer (26% versus 14%, p = 0.002). Considering the main confounding factors, a binomial logistic model indicated that the cumulative clinical pregnancy rate was not significantly affected when a single embryo transfer was performed in women recovering up to nine oocytes. Similar results were obtained comparing cases and controls within subgroups: 2-4 or 5-9 oocytes; &amp;lt;35 or 35–39 or &amp;gt; 39 years female age). Limitations, reasons for caution This study does not have the statistical power to highlight small differences between the two groups. It was conducted on a specific population of women with 9 or less oocytes therefore results cannot be generalized to other populations, particularly those with a better or poorer prognosis. Wider implications of the findings eSET results are mainly based on good prognosis couples. Despite a trend for better success after fresh DET, cumulative results are not affected by eSET at the cleavage stage with significantly reduced incidence of twins and moderate delay in time to pregnancy also in poor/suboptimal responders. Trial registration number not applicable

Female Sexual Function in Twin Pregnancy.

Introduction: The incidence of twin pregnancy is estimated at 1 per 80 single pregnancies. As the topic of sexual function among women with multiple pregnancy is insufficiently developed, we believe it is appropriate to raise this subject. Methods: A prospective study was conducted on 100 women during subsequent trimesters of pregnancy. Results: From a group of 100 women, 54 women were primiparous, while 46 women had a history of previous delivery. The mean overall FSFI (female sexual function index) was found to be 24.3 ± 6.1. Mean FSFI was the highest in the first trimester at 25.6. The result decreased successively to 24.8 ± 7 and 22.6 ± 8.4 in the second and third trimesters, respectively. The patient’s place of residence had a crucial impact on their FSFI score. The results were considerably higher for residents of small and medium towns or cities—24.4 ± 3.8 and 25.9 ± 4.9, respectively—while for those living in rural areas, the FSFI reached only 21.7 ± 5.4. Conclusions: The present study shows that the FSFI decreased throughout twin pregnancy. The lowest observed FSFI occurred in the third trimester, while the highest FSFI occurred during the first trimester.

Clinical data analysis of nine years of experience with twin pregnancy: a tertiary hospital-based retrospective study

Background: The incidence of twin pregnancy has been increasing worldwide and in China. This study provided a comprehensive analysis of the clinical data of twins in a Chinese tertiary hospital and summarized the clinical characteristics. Methods: A retrospective collection of data was carried out for 717 cases of twins in the Obstetrics Department of the First Affiliated Hospital of Xi’an Jiaotong University from 2011 to 2020. A comprehensive analysis of baseline information and maternal and perinatal outcomes was conducted, and the twin birth rate of the study population was also calculated. Results: The average twin delivery rate was 2.61%. A total of 206 cases were monochorionic, and 511 cases were dichorionic. Premature delivery, hypertensive disorder complicating pregnancy and premature rupture of membranes were the three most common complications. Caesarean section rates from 2011 to 2019 were maintained at 70%–80%. A total of 144 cases (20.08%) of 717 twin cases were complicated twins. Birthweight discordance ≥25% accounted for 13.53% of cases. Adverse neonatal outcomes with higher incidences were neonatal respiratory distress syndrome, small for gestational age and 1 min Apgar score ≤7. Conclusions: Twin pregnancy has different and unique clinical features. Obstetricians should pay close attention to its clinical management to obtain better perinatal outcomes.

Gestational Weight Gain and Its Effects on Maternal and Neonatal Outcome in Women With Twin Pregnancies: A Systematic Review and Meta-Analysis

Background: The incidence of twin pregnancies has risen recently. Such pregnancies are associated with an increased risk for poor maternal and infant outcomes. Gestational weight gain, particularly in singleton pregnancies, has been well-linked with maternal and infant outcomes. The aim of the current meta-analysis was to evaluate the effects of gestational weight gain on maternal and fetal outcomes in women with twin pregnancies.Methods: A systematic search was conducted using the PubMed, Scopus, and Google Scholar databases. Studies, either retrospective or prospective in design, evaluating the effects of gestational weight gain (defined using Institute of Medicine (IOM) guidelines) maternal and/or fetal/neonatal outcomes in women with twin pregnancies were included. Statistical analysis was performed using STATA software.Results: Eleven studies were included in the meta-analysis. Mothers with inadequate weight gain had increased risk for gestational diabetes mellitus (OR 1.19; 95% CI: 1.01, 1.40) and decreased risk for gestational hypertension (OR 0.58; 95% CI: 0.49, 0.68) and cesarean section (OR 0.94; 95% CI: 0.93, 0.96). Neonates born to mothers with inadequate weight gain were susceptible to increased risk for preterm delivery (OR 1.17; 95% CI: 1.03, 1.34), very preterm delivery (gestational age <32 weeks) (OR 1.84; 95% CI: 1.36, 2.48), small for gestational age status (OR 1.41; 95% CI: 1.15, 1.72), low birth weight status (<2,500 g) (OR 1.27; 95% CI: 1.17, 1.38), and neonatal intensive care unit (NICU) admission (OR 1.16; 95% CI: 1.08, 1.24). The pooled findings indicate an increased risk for gestational hypertension (OR 1.82; 95% CI: 1.60, 2.06) and cesarean section (OR 1.07; 95% CI: 1.05, 1.08) among mothers with excessive weight gain. Neonates born to mothers with excessive weight gain were susceptible to increased risk for preterm delivery and very preterm delivery, but were associated with a decreased risk for low birth weight status and small for gestational age status.Conclusions: Gestational weight gain in twin pregnancy, either lower or higher than IOM recommended guidelines, is associated with poor maternal and neonatal outcomes. Our findings call for incorporating counseling on optimal weight gain during pregnancy as part of routine antenatal visits.

Effect of adenomyosis on adverse obstetrical outcomes in twin pregnancies achieved with assisted reproductive technology

The incidence of twin pregnancy with adenomyosis (AD) is increasing due to advanced maternal age and infertility treatment. We retrospectively analysed the data of 45 dichorionic twin pregnancies complicated with AD in contrast to a control group of dichorionic twin pregnancies without AD (n = 130). Compared with those in the control group, the AD group had a higher overall foetal loss rate (8.9% vs. 0.8%; adjusted p = .031; odds ratio (OR), 13.6; 95% confidence interval (CI), 1.27–146.3), higher early preterm delivery rate (20% vs. 6.9%; adjusted p = .007; OR, 4.22; 95% CI, 1.47–12.13) and higher rate of hypertensive disorders of pregnancy (26.7% vs. 7.7%; adjusted p = .005; OR, 3.94; 95% CI, 1.5–10.2). Patients in the AD group were significantly more likely to require transfusion during or after delivery (17.8% vs. 5.4%; p = .026) and have smaller babies (2168 g vs. 2399 g; p = .004) compared with those in the control group. This is the first study to report that twin pregnancies with AD may be treated as high-risk for placental dysfunction and may need closer monitoring during pregnancy. Impact Statement What is already known on this subject? The incidence of twin pregnancy with adenomyosis (AD) is increasing due to advanced maternal age and infertility treatment. However, there are very few studies on the effect of AD on pregnancy outcomes. What the results of this study add? This is the first study to report that twin pregnancies with AD have higher rates of early preterm delivery, hypertensive disorders of pregnancy, and transfusion compared to controls. What the implications are of these findings for clinical practice and/or further research? The results of this study can be used in counselling twin pregnancies with AD. Further research is needed to confirm the current findings.

Preterm delivery risk in infertile women who conceived after reproductive surgery: natural conception versus IVF/ICSI.

Is preterm delivery an infertility treatment-related adverse outcome in infertile women who conceived after reproductive surgery? Compared with matched fertile women, preterm delivery appears to be a modest infertility treatment-related adverse outcome in infertile women who have reproductive surgery then conceived naturally or after IVF/ICSI. Most observational studies have shown that women who receive any infertility treatment are more likely to deliver preterm than do fertile women. However, studies on the outcome of pregnancies in infertile women who conceive naturally after reproductive surgery are scarce. This was a single-centre historical two-part study: cohort and matched cohort study. Anonymized data of 761 infertile women who conceived after reproductive surgery and 758 fertile women were obtained by linking three computerized databases from 1 July 2012 to 31 December 2015. In the cohort study, we evaluated the association between the mode of conception and preterm delivery <37 and <32 gestational weeks in 703 infertile women, with a singleton pregnancy who conceived after reproductive surgery, using logistic regression adjusted for relevant co-variates to calculate the adjusted odds ratio with a 95% CI. In the matched cohort study, we evaluated preterm delivery as infertility treatment-related adverse outcome using the propensity score (PS) method. The matched cohort comprised 758 infertile women and 758 fertile women with a twin or singleton pregnancy. Infertile women conceived after reproductive surgery either naturally or through IVF/ICSI. Infertile and fertile women were matched using PS matching. Infertile and fertile women were matched for pre-defined risk factors for preterm delivery. Three infertile women out of an original 761 were not included in the analysis because they lacked all required matching variables. We performed a 1:1 matching with an optimal matching algorithm with a caliper width of the linear predictor of 0.1 standard deviations. The effect of reproductive surgery on preterm delivery was evaluated in the PS-matched sample using Pearson's χ2 test and presented as the odds ratio (OR) with 95% CI. All women delivered at the Department of Perinatology, University Medical Centre Ljubljana, Slovenia. Among 761 infertile women who conceived after reproductive surgery, 428 (56.2%) women conceived naturally and 333 (43.8%) conceived after IVF/ICSI. The incidence of twin pregnancies was significantly lower after natural conception (2.6% vs 14.1%). Among the 703 infertile women with a singleton pregnancy, 417 (59.3%) conceived naturally and 286 (40.7%) conceived after IVF/ICSI. Adjusted for maternal age and parity in infertile women with singleton pregnancies, IVF/ICSI showed a moderate association with preterm delivery <32 weeks. Compared with natural conception after reproductive surgery, the odds for preterm delivery after IVF/ICSI was 1.07 (95% CI 0.63-1.81) <37 weeks and 2.25 (95% CI 0.80-6.34) <32 weeks. Preterm delivery appears to be a modest infertility treatment-related adverse outcome. Compared with fertile women in the PS-matched sample, infertile women who conceived after reproductive surgery either naturally or after IVF/ICSI the odds of preterm delivery <37 weeks were 1.31 (95% CI 0.97-1.78) and odds of preterm delivery <32 weeks were 1.57 (95% CI 0.78-3.18). However, none of the estimations were statistically significant. The main limitations of the study were the retrospective design, the heterogeneity of the types of reproductive surgery performed and underlying reproductive pathologies. The low number of preterm deliveries in the present study might influence the precision of estimations. The present study aims to alter the prevailing opinion that reproductive surgery should only be considered preceding IVF to increase implantation and pregnancy rates after IVF. It implies that in selected infertile women who have had reproductive surgery, a high rate of natural conception, a low rate of multiple pregnancies, and a modest infertility treatment-related effect on preterm delivery should be the reasons to encourage natural conception after reproductive surgery. Furthermore, by allowing for natural conception, we can avoid a high-cost invasive medical procedure. The study received no funding. We have no competing interest to declare. N/A.

Kliniğimizde doğum yapan ikiz gebeliklerin değerlendirilmesi: Üç yıllık deneyim

Objective: Twin pregnancies constitute 1–2% of all pregnancies. With the recent developments in assisted reproductive technologies, the incidence of multiple pregnancy has increased. Preterm labor is held responsible for the poor neonatal outcomes primarily. In our study, we aimed to assess fetal-maternal outcomes of twin pregnancies seen in our clinic. Methods: One hundred and thirty twin pregnancy cases out of 4241 pregnant women who delivered in our clinic between 01.01.2017 and 01.01.2020 were included in the study. The labor records of the patients were reviewed retrospectively and their data for age, week of gestation, delivery type, birth weight, fetal sex, chorionicity characteristics and laboratory parameters were recorded. Definitive statistics and SPSS 21.0 for statistical analyses were used to evaluate the data obtained from the study. The data were presented as mean ± SD (standard deviation). Results: The incidence of twin pregnancy was found 3%. In the ultrasonographic imaging evaluated during diagnosis, 27.7% of the cases were monochorionic and 72% of them were dichorionic. Of the pregnant women, 12.3% were at term and 87.7% were at preterm period. When the preterm fetuses were evaluated, 37.7% of 114 preterm fetuses were delivered at late preterm period, 29.2% of them at mid-preterm period and 20.8% at premature preterm period. The rates of treatment pregnancy (pregnancy provided by ovulation induction and assisted reproductive technologies) and spontaneous twin pregnancy were 20% and 80%, respectively. Mean maternal age was found 31.3. When evaluated in terms of maternal morbidity, preterm labor and premature rupture of membrane were the most common problems. Mean newborn weight was 1832g and 59.3% of the newborns had low birth weight and 21.8% of them had very low birth weight. While one fetus had transverse presentation in 12.5% of the patients, at least one fetus had breech presentation in 53.1% of the cases and 34.4% of the cases had head-head presentation. Conclusion: Twin pregnancies are characterized by the increased feto-maternal risks. Therefore, both antenatal and intrapartum management should be maintained diligently.

To What Extent Does Photoperiod Affect Cattle Reproduction? Clinical Perspectives of Melatonin Administration – A Review

Abstract The seasonality of reproduction in most mammals is dictated by photoperiod, temperature and nutrition. Melatonin, mainly synthesized in the pineal gland, is generally accepted as the active mediator of photoperiod responses including reproduction. While non-pregnant heifers and cows show continuous sexual activity and are therefore not seasonal breeders, it has been suggested that photo-periodicity may influence the appearance of puberty in heifers and the onset of parturition. Further, the light/dark ratio may influence endocrine patterns of gestation and a shorter light period correlates with the incidence of twin pregnancies. This review considers specific aspects of the effects of photoperiod and melatonin on reproduction in dairy cattle and discusses the clinical applications of melatonin.

Fetomaternal Outcome in Twin Pregnancies: A Retrospective Analysis from a Tertiary Care Centre

Introduction: Twin pregnancies are among the major challenges faced by obstetricians globally. Increased maternal and foetal morbidity is observed with an increase in the incidence of twin pregnancies. Due to elevated rates of complications, a larger number of caesarean sections are performed in twin pregnancies in comparison to singleton gestation. Aim: The study aimed to find out the incidence of twin pregnancy with associated maternal risk factors and foetal outcome in the study population. Materials and Methods: This retrospective observational study was carried out at JNU Hospital and Medical College, Jaipur for a period of 4 years from December 2015 to December 2019. A total of 70 mothers, who presented with twin pregnancy, were included in this study. Data were collected from hospital records regarding maternal age, parity, whether spontaneous or assisted conception, gestational age, pregestational Body Mass Index (BMI) and family history. Details of maternal and foetal complications that occurred during the antenatal period and labour as well as the mode of delivery were collected and analysed. Statistical significance was considered if the p-value was ≤0.05. Qualitative data were represented as rate and proportions, while quantitative data were represented as mean and standard deviation. Results: A total of 70 mothers with twin births, resulting in 140 babies during the 4 years study period were included. A total of 4240 deliveries overall during the study period, gave a twin pregnancy incidence rate of 16.5 in 1000 deliveries. Preterm labour (25.4%), anaemia (26.8%) and hypertension (22.5%) were common problems. The most common indication for caesarean delivery was foetal malpresentation (37.8%) The mean weight of the first twin was 2.12±0.35 kg while the mean weight of the second twin was 1.97±0.30 kg. Among foetal complications, Intrauterine Growth Restriction (IUGR) was seen in 11.4% and birth weight discordance in 21.4% of children. A low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score was noted in 21.4% of babies, while 12.9% of babies died in the early neonatal period. Conclusion: Maternal complications during twin pregnancy were mainly preterm labour, diabetes, hypertension and anaemia. Caesarean section was the main mode of delivery in this study with significant association with hypertension and preterm labour. Foetal complications were in the majority related to IUGR. More vigilance during the antenatal period and labour is needed for proper selection of mode of delivery. Active foetal surveillance and intervention with appropriate neonatal care can improve fetomaternal outcome.

Maternal complications in twin pregnancies in Finland during 1987\u20132014: a retrospective study

BackgroundTo investigate the trends and changes in the incidence and overall outcome of twin pregnancies in Finland, a retrospective study was conducted with emphasis on maternal complications, covering a 28-year study period.MethodsAll 23,498 twin pregnancies with 46,363 live born and 633 stillborn children in Finland during 1987–2014 were included in the study. Data were collected from the national Medical Birth Register and the Care Register on Hospital Care (Finnish Institute for Health and Welfare, Finland) regarding the parturients’ characteristics and incidences of several pregnancy and childbirth complications. The incidences of twin pregnancies and maternal complications during pregnancy and childbirth are the main outcome measures of the study. The results are expressed in percentages, means, medians, ranges and standard deviations (SD), when appropriate.ResultsTwins comprised 1.4% of all births in Finland in 1987–2014. Parturients’ mean age has remained stable, but the share of over 35 year-old parturients is increasing. The incidences of pre-eclampsia, intrahepatic cholestasis of pregnancy, gestational diabetes and postpartum haemorrhage have risen during the study period. Almost half (44.9%) of twins were born preterm, almost half via Caesarean section (47.1%), and 27.7% of twin labours were induced.ConclusionsSeveral pregnancy complications increased during the study period. Advanced maternal age among twin parturients has risen, enhancing the risks for developing complications in a pregnancy already of a high-risk category, and predisposing to preterm delivery. National and international guidelines are necessary to improve the overall outcome of twin pregnancies.

Percentile charts of twin birthweight.

The birthweight of multiples is naturally lower than that of singletons. Given that the incidence of twin pregnancy has risen in recent years, it seems reasonable to create standards of birthweight separately for twins. This could help in the objective assessment of small and large for gestational age twin newborns. The main goal of this study was therefore to construct and present up-to-date birthweight references. The present percentile charts for twins are based on a cohort retrospective study of 757 pairs of twins (767 boys and 709 girls) born between weeks 25 and 39 of gestation. Mean and standard deviation were calculated for the subsequent weeks of gestation. Percentiles were read for the subsequent gestational age. The obtained curves were smoothed with a fifth-degree polynomial function. The significance of differences between the 50th percentile values for twins and singletons was estimated using median test. In both sexes, a continuous observable trend occurs of a significantly lower average birthweight for twins. Differences increase with increasing gestational age and are greater in girls. The estimated 50th percentile for twins was greater than the estimated 10th percentile for singletons. This supports the notion of discordant growth as a physiological adaptation that promotes maturity. Percentile charts for singletons are not applicable for twins. This indicates the importance of applying separate percentile charts for twins, enabling objective evaluation of their health status and identifying deviations from normality.