Obstetric Outcomes Of Twin Pregnancies Research Articles

Effects of vaginal microbiota and cervical cerclage on obstetric outcomes of twin pregnancies with cervical incompetence: a retrospective study.

To determine the role of vaginal microbiota in the efficacy of cervical cerclage in obstetric outcomes of twin pregnancies. This retrospective study enrolled 68 twin pregnant women diagnosed with cervical incompetence (CIC) and 68 twin pregnancies without CIC. The CIC group was further divided into two subgroups: cerclage group (n = 51) and non-cerclage group (n = 17), according to whether cervical cerclage was performed in the second trimester. Data of vaginal microbiota and obstetric outcomes were collected and compared. Cervical incompetence had harmful effect on both pregnancy outcomes and vaginal microecology, characterized by earlier gestational week at delivery (30.3 ± 5.6 vs 35.6 ± 1.1, P < 0.001), a lower birth weight of newborns (OR 0.40; 95% CI 0.22-0.74), a higher vaginal pH value (OR 0.11; 95% CI 0.04-0.30) and a lower abundance of Lactobacillus (OR 0.34; 95% CI 0.17-0.70). In addition, compared with the vaginal microbiota after cerclage, less normal diversity of bacterial flora (OR 0.35; 95% CI 0.12-1.01), less Lactobacillus (OR 0.40; 95% CI 0.18-0.91) and more Gardnerella vaginalis (OR 18.92; 95% CI 2.38-150.35) appeared before cerclage. Besides, the unhealthy vaginal environment also had an unfavorable influence on the neonatal outcomes, increased neonatal mortality rate was observed in the group of vaginal pH > 4.5 (P < 0.05). Fortunately, compared with the non-cerclage group, the cerclage group had a longer interval from diagnosis to delivery (≥ 8weeks) and more of the newborns' birth weight were not less than 1500g (P < 0.05). A healthy vaginal environment is essential to improve the obstetric outcome for twin pregnancies with cervical cerclage.

Obstetric outcomes of twin pregnancies presenting with a complete hydatidiform mole and coexistent normal fetus: a systematic review and meta-analysis.

Epidemiological data on obstetric and oncologic complications in twin pregnancies combining a complete hydatidiform mole (CHM) coexisting with a normal fetus and placenta are limited. To evaluate perinatal and obstetric outcomes for mother and fetus and risk of gestational trophoblastic neoplasia (GTN) in twin pregnancies including a CHM. PubMed, MEDLINE and EMBASE and the grey literature were searched for articles published between May 1980 and May 2019 using a protocol designed a priori and registered on PROSPERO (CRD42018112524). Observational cohort studies of four or more cases confirmed by histopathology and providing data on pregnancy outcomes and GTN. Two reviewers independently reviewed abstracts and full-text articles. The quality of the studies was assessed with the Newcastle-Ottawa scale and a meta-analysis was performed. Of the 344 abstracts identified, 14 studies (244 cases) met the eligibility criteria. The incidence of maternal complication in ongoing pregnancies was 80.8% and included vaginal bleeding, hyperthyroidism and pre-eclampsia. There were overall 91 (50%) live births in ongoing pregnancies and 83 (34%) of the total cases were subsequently diagnosed with GTN. Substantial and significant (P<0.001) heterogeneity was found for the incidence of preeclampsia indicating variability in reporting the incidence of some obstetric complications between studies. Patients diagnosed with a twin pregnancy combining a CHM and an apparently normal fetus have a high risk of perinatal complications, low live-birth rates and around a third of them will develop a GTN and should be managed by specialised multidisciplinary teams. Our study indicates a high rate of obstetric and oncologic complications in patients presenting with a complete hydatidiform mole and coexistent normal fetus.

Obstetric outcomes of twin pregnancies at advanced maternal age: A retrospective study

ObjectiveTo evaluate obstetric outcomes in twin pregnancies of advanced maternal age (≥35 years). Materials and methodsA retrospective study involved 470 twin pregnancies in a single center from Sep. 1, 2012 to Mar. 31, 2015. Clinical characteristics and obstetric outcomes were recorded and compared among twin pregnancies who were classified as follows: age 20–29, 30–34, 35–39 and ≥40 years. ResultsThe incidence of gestational diabetes (age 20–29 years 15.8%; 30–34 years 24.3%; 35–39 years 30.4%; ≥40 years 57.1%; p = 0.004) and premature delivery (20–29 years 58.6%; 30–34 years 69.1%; 35–39 years 72.2%; ≥40 years 85.7%; p = 0.001) significantly increased with increasing age whereas spontaneous abortion (20–29 years 27.6%; 30–34 years 11.6%; 35–39 years 11.4%; ≥40 years 0.0%; p = 0.021) decreased in twin pregnancies of advanced maternal age. In addition, the rate of postpartum hemorrhage increased almost continuously by age and advanced maternal age was described as a risk factor for postpartum hemorrhage (age 35–39, adjusted OR 3.377; 95% confidence interval 1729–6.598; p < 0.001; age ≥ 40, adjusted OR 10.520; 95% CI 1.147–96.492; p = 0.037). However, there was no significant difference between advanced maternal age and adverse neonatal outcomes. ConclusionIn twin pregnancies, advanced maternal age experienced significant higher risk of postpartum hemorrhage, gestational diabetes and premature delivery. Neither adverse neonatal outcomes nor stillbirth was significantly associated with maternal age.

Obstetric Outcomes of Twin Pregnancies in Japanese Women Aged 40 and Older.

BackgroundThe aim of this study was to compare the obstetric outcomes of twin pregnancies between Japanese women aged ≥ 40 years and their younger counterparts aged 25 - 29.MethodsThis was a retrospective study of twin pregnancies managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2016. Women aged 40 and older at delivery (n = 117) were compared with women aged 25 - 29 at delivery (n = 536).ResultsAlthough the women ≥ 40 years old were more likely to have increased risks of HELLP (hemolytic, elevated liver enzymes and low platelet) syndrome and very low birth weight neonates, there were no measurable differences in obstetric outcomes such as hypertensive disorders, premature delivery and neonatal asphyxia between the two groups.ConclusionAdvanced maternal age did not seem to affect obstetric outcomes in twin pregnancies seriously.

Prophylactic cerclage in twin pregnancies from art: obstetric outcomes

To compare the obstetric outcomes of twin pregnancies after ART with and without prophylactic cerclage (McDonald technique). Cohort prospective study. A total of 129 patients were included, all of them carrying a twin pregnancy resulted from ART between years 2007-2010. Prophylactic cerclage was performed in 46 while the remaining 83 served as controls. The decision about performing or not the cerclage was taken randomly by each attending physicians and all the patients were followed up to delivery. All the demographic characteristics between groups (cerclage and no cerclage) were comparable: age (33.1 ± 5.4 vs 33.8 ± 5.21), weight (68.1 ± 13.7 vs 67.5 ± 12.32kg), height (1.59 ± .066 vs 1.56 ± .077mts), BMI (26.4 ± 5.00 vs 23.0 ± 1.94), FSH day 3 (7.6 ± 6.04 vs 10.49 ± 12.2 IU), LH day 3 (4.03 ± 2.94 vs 5.81 ± 5.23 IU), E2 day 3 (57.6 ± 47.9 vs 57.07 ± 60.6 pg/dL) and PRL (17.46 ± 7.60 vs 16.96 ± 12.32 ng/ml). Similarly there were no differences in day of retrieval (12.67 ± .93vs12.59 ± 6.11), aspirated oocytes (12.83 ± 5.3vs11.70 ± 7.23), MII oocytes (10.32 ± 5.30vs9.77 ± 6.73), injected/inseminated (10.86 ± 5.43vs9.65 ± 5.79), fertilization rate (64%vs74%), day of transfer (2.96 ± 0.81vs2.95 ± 0.72), embryos transferred (2.87 ± 0.65vs3.02 ± 0.62). Among the obstetric variables, a significant difference was observed in gestational weeks (35.65 ± 1.96 vs. 33.79 ± 5.28,P<0.05), average weight (2358.8 ± 462.73 vs.2103.90 ± 711.78, P<0.05). Patients with twin pregnancy and prophylactic cerclage had a better gestational age and better birth weight compared to those without cerclage. Prophylactic cervical cerclage should be considered as routine in twin pregnancies from ART.

Twin versus singleton pregnancies: the incidence, pregnancy complications, and obstetric outcomes in a Nigerian tertiary hospital

Background:Twin pregnancy is associated with more pregnancy complications and poorer pregnancy outcome than singleton pregnancy. Hence periodic review is necessary to improve on the pregnancy outcome.Objective:To determine the incidence and compare pregnancy complications and obstetric outcomes of twin pregnancies and singleton pregnancies.Materials and methods:The twin pregnancies (study group) that were delivered at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-East Nigeria from 1st February 2005 to 31st January 2010 were compared with singleton deliveries (control group) that occurred in the same hospital during the same period.Results:A total of 3351 deliveries were conducted during the study period, of which 113 were twin deliveries, giving an incidence of 1:29.6 deliveries. Only 100 case files could be retrieved for analysis. The mean parities for the twins and singletons were 2.7 ± 2.33 weeks and 1.96 ± 1.87 weeks whereas the mean gestational age at delivery for twin and singleton deliveries were 34 ± 5.2 weeks and 38.7 ± 2.4 weeks respectively (P < 0.05). The mean birth weights were 3.14 ± 0.73 kg and 2.3 ± 1.0 kg for singletons and twins respectively (P < 0.05). Hypertensive disorders of pregnancy, cord prolapse, malpresentation, premature rupture of membranes, low Apgar scores, cesarean section rate, and perinatal death were significantly higher in twin pregnancies than in singleton.Conclusion:The incidence of twin pregnancy over the study period was high and was significantly associated with more pregnancy complications and poorer obstetric outcomes. Close antenatal and intrapartum care are needed in order to improve outcome and decrease complications.

Outcome of twin gestations after first trimester chorionic villus sampling

Objective: To tabulate genetic results and obstetric outcomes of twin pregnancies after first-trimester chorionic villus sampling (CVS). Methods: The study included 262 consecutive women with twin pregnancies who had first-trimester CVS between 1988 and 1998. Results: Major indications for prenatal diagnosis included maternal age ( n = 82), pregnancies after intracytoplasmic sperm injection ( n = 114), or both ( n = 33). Among 524 fetuses, 519 were sampled adequately. Cytogenetic results were incorrect because of sampling the same fetus twice in two pregnancies. In three pregnancies, contamination caused by mixed sampling made cytogenetic results uncertain. Correct genetic diagnoses were obtained in 509 fetuses, 24 of which had chromosomal abnormalities on direct preparations and four of which had monogenetic conditions. Additional invasive procedures were done on five occasions. Fifteen fetuses were terminated selectively. The total fetal loss rate was 5.5% (28 of 509). The indication for the procedure did not significantly determine the fetal loss rate. The mean ± standard deviation (SD) gestational age at birth was 35.9 ± 2.9 weeks, and the mean ± SD birth weights for twins A and B were 2429 ± 589.1 g and 2378 ± 588.5 g, respectively. Conclusion: First-trimester CVS is an accurate means of prenatal genetic diagnosis in twins, offering early selective termination in cases of abnormal genetic results in one of the fetuses.

Outcome of Twin Gestations After First Trimester Chorionic Villus Sampling

In Brief Objective To tabulate genetic results and obstetric outcomes of twin pregnancies after first-trimester chorionic villus sampling (CVS). Methods The study included 262 consecutive women with twin pregnancies who had first-trimester CVS between 1988 and 1998. Results Major indications for prenatal diagnosis included maternal age (n = 82), pregnancies after intracytoplasmic sperm injection (n = 114), or both (n = 33). Among 524 fetuses, 519 were sampled adequately. Cytogenetic results were incorrect because of sampling the same fetus twice in two pregnancies. In three pregnancies, contamination caused by mixed sampling made cytogenetic results uncertain. Correct genetic diagnoses were obtained in 509 fetuses, 24 of which had chromosomal abnormalities on direct preparations and four of which had monogenetic conditions. Additional invasive procedures were done on five occasions. Fifteen fetuses were terminated selectively. The total fetal loss rate was 5.5% (28 of 509). The indication for the procedure did not significantly determine the fetal loss rate. The mean ± standard deviation (SD) gestational age at birth was 35.9 ± 2.9 weeks, and the mean ± SD birth weights for twins A and B were 2429 ± 589.1 g and 2378 ± 588.5 g, respectively. Conclusion First-trimester CVS is an accurate means of prenatal genetic diagnosis in twins, offering early selective termination in cases of abnormal genetic results in one of the fetuses. Chorionic villus sampling in twin pregnancies provides reliable genetic results, has a low complication rate, and offers the advantage of early selective termination in cases of discordant test results.

Multifetal reduction of high-order multiple pregnancy: comparison of obstetrical outcome with nonreduced twin gestations

To compare the obstetric outcomes of twin pregnancies obtained as a result of multifetal pregnancy reduction to those in which pregnancy reduction had not been used. Retrospective analysis. University-based tertiary care infertility clinic. Seventy-four twin pregnancies continuing beyond 10 weeks. Of these, 32 gestations had undergone reduction to twins at 10 weeks. Gestational age at delivery, birth weights, pregnancy complications. All pregnancies advanced beyond 20 weeks gestation. The mean gestational age at delivery of the reduction group was 33.8 versus 35.7 weeks in the nonreduced group; only 25% of reduced pregnancies reached 37 weeks compared with 57.9% of nonreduced twins. The mean fetal birth weights of the two groups differed significantly (reduced: 2,038 g, nonreduced: 2512 g). The gestational age at delivery in patients reduced from triplets was significantly greater than in pregnancies reduced from quadruplets or higher. Multiple regression analysis revealed that for a given gestational age at delivery, a history of pregnancy reduction was associated with decreased birth weight. These data suggest that multifetal pregnancy reduction does not reverse completely the decreased gestational age and impaired fetal growth associated with high-order multiple pregnancy. Furthermore, fetal growth of reduced pregnancies seems to be impaired independent of the gestational age at which delivery occurs.