Outcome Of Twin Pregnancies Research Articles

The Study of Fetomaternal Outcomes in Twin Pregnancy with Single Fetal Demise

The Study of Fetomaternal Outcomes in Twin Pregnancy with Single Fetal Demise

Neonatal and maternal outcomes with elective cesarean section compared to induction of labor in twin pregnancies: A prospective cohort study

ObjectivesThe aim of this study was to compare neonatal and maternal outcomes in twin pregnancies with elective cesarean section (ECS) and induction of labor (IOL) to better inform women during the counselling process. Materials and methodsWe conducted a cohort study including all twin pregnancies referred to the Department of Obstetrics at Kolding University Hospital, Denmark between January 2007 to April 2019 (n = 819). The primary analysis compared maternal and neonatal outcomes in pregnancies planned for IOL with those planned for ECS after week 34. A secondary analysis compared maternal and neonatal outcomes in pregnancies who underwent IOL followed by successful vaginal delivery with outcomes in those who underwent ECS. ResultsAmong 587 eligible twin pregnancies, the rates of unplanned CS did not differ between those planned for ECS compared to those planned for IOL (38% vs. 33%; p = 0.27). IOL resulted in successful vaginal delivery in 67% (155/231) of those planned for IOL. Maternal outcomes did not differ between women who were planned for, or received, delivery with either IOL or ECS. Regarding neonatal outcomes, significantly more neonates required treatment with C-PAP in ECS group, than in the IOL group, and a higher median number of maturity days among mothers planned for ECS. However, no other significant difference in neonatal outcomes was observed when comparing successful IOL with successful ECS. ConclusionInduction of labor was not associated with worse outcomes compared to elective caesarean section in this large cohort of routinely handled twin pregnancies. In women with twin pregnancies indicated for delivery, who does not go into spontaneous labor, induction of labor is a safe option for both the mothers and their neonates.

Race and Ethnicity and Disparities in Neonatal Outcomes in Twin Pregnancies [ID: 1375610

INTRODUCTION: Twin pregnancies are associated with adverse neonatal outcomes. We aimed to investigate disparities in neonatal outcomes by maternal race and ethnicity. METHODS: This was an IRB-approved, retrospective cohort of twin deliveries at a single institution between 2001 and 2018. Pregnancies delivered less than 23 weeks’ gestational age (GA), fetal demise, or major anomaly were excluded. The primary exposure, race and ethnicity, was self-reported as follows: non-Hispanic White, Hispanic, non-Hispanic Black, Asian/Pacific Islander, and other/mixed race. The primary outcome was neonatal intensive care unit (NICU) admission of at least one twin. Secondary outcomes included 5-minute Apgar less than 7 for either twin, GA at delivery, small for GA (SGA) neonate (<10th percentile for GA), and NICU length of stay. Chi-square, ANOVA, and Student’s t test were performed for univariate analyses. Logistic regression modeling was performed to control for baseline differences. RESULTS: Eight hundred four twin pregnancies were identified; 48% of patients identified as non-Hispanic White, 30% as Hispanic, 10% as Asian/Pacific Islander, 5.6% as non-Hispanic Black, and 6.6% as other/mixed race. Age, parity, chorionicity, and body mass index differed between groups. The overall rate of NICU admission was 77.5% and did not differ by race and ethnicity (P=.05). Pregnancies with at least one SGA neonate varied significantly by race and ethnicity (P=.02). Gestational age at delivery, Apgar of less than 7, and ICU length of stay did not differ. CONCLUSION: The risk of having an SGA neonate varies by race and ethnicity in twin gestations, with highest rates among non-Hispanic Black women. Additional racial and ethnic disparities in neonatal morbidity were not found. Disparities in rate of preterm birth were not seen in this cohort.

Does structured obstetric management play a role in the delivery mode and neonatal outcome of twin pregnancies?

PurposeWhile the optimal delivery method of twin pregnancies is debated, the rate of cesarean deliveries is increasing. This retrospective study evaluates delivery methods and neonatal outcome of twin pregnancies during two time periods and aims to identify predictive factors for the delivery outcome.Methods553 twin pregnancies were identified in the institutional database of the University Women’s Hospital Freiburg, Germany. 230 and 323 deliveries occurred in period I (2009–2014) and period II (2015–2021), respectively. Cesarean births due to non-vertex position of the first fetus were excluded. In period II, the management of twin pregnancies was reviewed; adjusted and systematic training with standardized procedures was implemented.ResultsPeriod II showed significantly lower rates of planned cesarean deliveries (44.0% vs. 63.5%, p < 0.0001) and higher rates of vaginal deliveries (68% vs. 52.4%, p = 0.02). Independent risk factors for primary cesarean delivery were period I, maternal age > 40 years, nulliparity, a history with a previous cesarean, gestational age < 37 completed weeks, monochorionicity and increasing birth weight difference (per 100 g or > 20%). Predictive factors for successful vaginal delivery were previous vaginal delivery gestational age between 34 and 36 weeks and vertex/vertex presentation of the fetuses. The neonatal outcomes of period I and II were not significantly different, but planned cesareans in general were associated with increased admission rates to the neonatal intensive care units. Inter-twin interval had no significant impact on neonatal outcome.ConclusionStructured regular training of obstetrical procedures may significantly reduce high cesarean rates and increase the benefit–risk ratio of vaginal deliveries.

Gestational Diabetes Mellitus Does Not Worsen Obstetrical and Neonatal Outcomes of Twin Pregnancy.

The specific effects of gestational diabetes mellitus (GDM) on twin pregnancy outcomes, which are at high risk per se, are unclear. The present study analyzes outcomes of twin pregnancies complicated by GDM (n = 227) by comparing them with GDM singleton pregnancies (n = 1060) and with twin pregnancies without GDM (n = 1008), all followed up at Sant'Anna Hospital, Turin (Italy), between January 2010 and March 2020. The prevalence of GDM among twin pregnancies (n = 1235) was 18.4%. Compared to GDM singletons, GDM twins had higher rates of preeclampsia (aOR 2.0; 95% CI 1.2-3.8), cesarean section (aOR 7.5; 95% CI 5.2-10.8), and neonatal hypoglycemia (aOR 2.5; 95% CI 1.1-5.3). They had a higher incidence of abnormal 2 h OGTT values (aOR 7.1; 95% CI: 3.2-15.7) and were less likely to require insulin therapy (aOR 0.5; 95% CI: 0.3-0.7). In comparison with twin pregnancies without GDM, women with GDM twins were significantly older (35.0 vs. 33.0 years; p < 0.001) and had higher BMI (23.0 versus 22.0 kg/m2; p < 0.001); they had a higher incidence of LGA newborns (aOR 5.3; 95% CI 1.7-14.8), and lower incidence of low APGAR scores (0.5; 95% CI 0.3-0.9). Overall, GDM does not worsen outcomes of twin pregnancy, which is per se at high risk for adverse outcomes.

Neonatal and developmental outcomes of very preterm twins according to the chorionicity and weight discordance

Perinatal outcomes of twin pregnancies are determined by several factors, such as gestational age (GA), chorionicity, and discordance at birth. This retrospective study aimed to investigate the association of chorionicity and discordance with neonatal and neurodevelopmental outcomes in preterm twin infants from uncomplicated pregnancy. Data of very preterm twin infants who were both live-born between 2014 and 2019 on the chorionicity of the twin, diagnosis of the twin-to-twin syndrome (TTTS), weight discordance at birth, and neonatal and neurodevelopmental outcomes at 24 months of corrected age (CA) were collected. Of the 204 twin infants analyzed, 136 were dichorionic (DC) and 68 were monochorionic (MC), including 15 pairs with TTTS. After adjusting for GA, brain injury, including severe intraventricular hemorrhage and periventricular leukomalacia, was mostly found in the MC with TTTS group, with a higher incidence of cerebral palsy and motor delay at CA 24 months. After excluding TTTS, multivariable analysis showed no association between chorionicity and neonatal and developmental outcomes, whereas small infants among co-twins (adjusted odds ratio (aOR) 3.33, 95% confidence interval 1.03–10.74) and greater discordance (%) of weight at birth (aOR 1.04, 1.00–1.07) were associated with neurodevelopmental impairment. Monochorionicity might not determine adverse outcomes among very preterm twins from uncomplicated pregnancy.

High-Order Parity Improves the Perinatal Outcome of Twin Deliveries.

Twin gestations are associated with an increased risk of obstetric and perinatal complications. We studied the association between parity and the rate of maternal and neonatal complications in twins deliveries. We performed a retrospective analysis of a cohort of twin gestations delivered between 2012 and 2018. Inclusion criteria consisted of twin gestation with two nonanomalous live fetuses at ≥24 weeks' gestation and no contraindications to vaginal delivery. Women were divided into three groups based on parity: primiparas, multiparas (parity of 1-4), and grand multiparas (parity ≥5). Demographic data were collected from electronic patient records and included maternal age, parity, gestational age at delivery, need for induction of labor, and neonatal birth weight. The primary outcome was mode of delivery. Secondary outcomes were maternal and fetal complications. The study population included 555 twin gestations. One hundred and three were primiparas, 312 were multiparas, and 140 were grand multiparas. Sixty-seven (65%) primiparas delivered the first twin vaginally, as did 294 (94%) multiparas and 133 (95%) grand multiparas (p <0.05). Thirteen (2.3%) women required delivery of the second twin by cesarean section. Among those who delivered both twins vaginally, there was no significant difference in the average time interval between the delivery of the first and the second twins between the groups. The need for transfusion of blood products was higher in the primiparous group compared with the other two groups (11.6 vs. 2.5 and 2.8%, p < 0.05). The rate of adverse maternal composite outcomes was higher among primiparous women compared with multiparous and grand multiparous (12.6, 3.2, and 2.8%, respectively, p < 0.05). The gestational age at delivery was earlier in the primiparous group compared with the other two groups, and the rate of preterm labor at <34 weeks' gestation was higher among the primiparas. The rate of second twin's 5-minute Apgar's score <7 and the composite adverse neonatal outcome among the primiparous group were significantly higher than the multiparous and grand multiparous groups. Our study demonstrates that there is an association between high-parity and good obstetric outcomes in twin pregnancies; high parity seems to serve as a protective, rather than a risk factor for adverse maternal and neonatal outcomes. · There is an association between high-parity and good obstetric outcome in twin pregnancies.. · High parity serves as a protective factor for adverse maternal outcomes in twin deliveries.. · High parity serves as a protective factor for adverse neonatal outcomes in twin deliveries..

Preterm Prelabour Rupture of Membranes before Viability in Twin Pregnancies: What Can We Expect?

Preterm prelabour rupture of membranes (PPROMs) before viability carries significant perinatal mortality and morbidity. Clinical management and prenatal counselling are a challenge, especially in twin pregnancies, due to scarce evidence on how previable PPROM affects this population. The aim of this study was to describe pregnancy outcomes of twin pregnancies complicated with previable PPROM and evaluate potential prognostic factors that may predict perinatal mortality. A retrospective cohort including dichorionic and monochorionic diamniotic twin pregnancies complicated with PPROM before 24 + 0 weeks of pregnancy was evaluated. Perinatal outcomes of pregnancies managed expectantly were described. Factors predicting perinatal mortality or reaching periviability (defined from 23 + 0 weeks onwards) were evaluated. Of the 45 patients included, 7 (15.6%) spontaneously delivered within the first 24 h after diagnosis. Two patients (5.3%) requested selective termination of the affected twin. In the 36 ongoing pregnancies that opted for expectant management, the overall survival rate was 35/72 (48.6%). There were 25/36 (69.4%) patients who delivered after 23 + 0 weeks of pregnancy. When periviability was achieved, neonatal survival increased up to 35/44 (79.5%). Gestational age at delivery was the only independent risk factor of perinatal mortality. The overall survival rate of twin pregnancies complicated with previable PPROM is poor but similar to singletons. No prognostic factors, apart from achieving periviability, were identified as individual predictors of perinatal mortality.

Pregnancy and perinatal outcomes of early vs late selective termination in dichorionic twin pregnancy: systematic review and meta-analysis.

To evaluate outcomes of dichorionic twin pregnancies undergoing early vs late selective termination of pregnancy (ST). MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to March 2022. The primary outcome of this study was pregnancy loss prior to 24 weeks' gestation. The secondary outcomes included preterm birth (PTB) before 37, 34, and 32 weeks, preterm prelabor rupture of membranes (PPROM), gestational age (GA) at delivery, Cesarean delivery, mean birth weight, 5-min Apgar score < 7, overall neonatal morbidity and neonatal survival. Only prospective or retrospective studies reporting data on the outcome of early (before 18 weeks) vs late (at or after 18 weeks) ST in dichorionic twin pregnancies were considered suitable for inclusion. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale for cohort studies. Random-effects head-to-head meta-analysis was used to analyze the data. Seven studies reporting on 649 dichorionic twin pregnancies were included in this systematic review. The risk of pregnancy loss prior to 24 weeks was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST (1% vs 8%; odds ratio (OR), 0.25 (95% CI, 0.10-0.65); P = 0.004). The risk of PTB was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST when considering PTB before 37 weeks (19% vs 45%; OR, 0.36 (95% CI, 0.23-0.57); P < 0.00001), before 34 weeks (4% vs 19%; OR, 0.24 (95% CI, 0.11-0.54); P = 0.0005) and before 32 weeks (4% vs 20%; OR, 0.21 (95% CI, 0.05-0.85); P = 0.03). The mean birth weight was significantly greater in the early-ST group (mean difference (MD), 392.2 g (95% CI, 59.1-726.7 g); P = 0.02), as was the mean GA at delivery (MD, 2.47 weeks (95% CI, 0.04-4.91 weeks); P = 0.049). There was no significant difference between dichorionic twin pregnancies undergoing early compared with late ST in terms of PPROM (P = 0.27), Cesarean delivery (P = 0.38), 5-min Apgar score < 7 (P = 0.35) and neonatal survival of the non-reduced twin (P = 0.54). The risk of pregnancy loss prior to 24 weeks and the rate of PTB before 37, 34 and 32 weeks were significantly higher in dichorionic twin pregnancies undergoing late vs early ST, thus highlighting the importance of early diagnosis of fetal anomalies in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Mid-trimester cerclage outcomes in singleton and twin pregnancies: a single tertiary center experience

Objective: The aim of this study was to evaluate the maternal and neonatal outcomes of patients who underwent ultrasonography (USG) and emergency-indicated cerclage in the mid-trimester in singleton and twin pregnancies. Methods: A total of 55 patients, 43 with singleton and 12 with twin pregnancies who underwent cerclage for short cervix (&lt;25 mm) or cervical dilation between January 2015 and December 2021 were included in the study. The primary outcome was gestational age at birth, and secondary outcomes were neonatal birth weight, the status of admission to neonatal intensive care unit, neonatal survival, and the neonatal birth rates at &lt;24 weeks, 24–27⁺⁶ weeks, 28–33⁺⁶ weeks, 34–36⁺⁶ weeks and &gt;37 weeks. Results: In singleton pregnancies, delivery interval was 15.05 (±2.9) weeks in the USG indication group and 2.8 (±2.5) weeks in the emergency indication group (p&lt;0.001). The rate of pregnant women in the USG indication group who gave birth between 24–27⁺⁶ weeks of gestation was 4.9% (n=2), and the rate of pregnant women in the emergency indication group was 55.6% (n=5) (p&lt;0.001). In total, in singleton pregnancies the rate of take-home baby was 85.7%, and neonatal mortality was 14.3%. In twin pregnancies, delivery interval was 12±1.41 weeks in the USG indication group, and it was 1.8±0.83 weeks in the emergency indication group (p&lt;0.003). In twin pregnancies, the take-home baby rate was 94% and neonatal mortality was 6%. Conclusion: Cervical cerclage reduces the possible risks of preterm delivery by prolonging the interval until delivery, especially in patients with singleton and twin pregnancies for whom USG is indicated, and promising neonatal outcomes are achieved.

Evaluating antenatal risk in twin pregnancies-A feasibility study to identify modifiable factors associated with adverse pregnancy outcomes.

Twin pregnancies have significantly higher rates of perinatal morbidity and mortality compared to singleton pregnancies; current attempts to reduce perinatal mortality have been less successful in twin pregnancies. The paucity of information about modifiable risk factors for adverse neonatal outcomes in twin pregnancies, as well as independent effects of chorionicity may have contributed to this outcome. This study aimed to explore the feasibility of an observational study to identify modifiable factors associated with adverse neonatal outcomes in twin pregnancies. Patients pregnant with twins at six UK hospitals between December 2019-March 2021 completed researcher-administered questionnaires at approximately 20-, 28- and 36-weeks' gestation, recording a wide range of self-reported social, lifestyle and demographic factors, alongside prospectively recorded clinical data from maternity records. Descriptive statistics were used to describe frequencies of exposures; logistic regression was used to determine whether factors were associated with a composite measure of adverse neonatal outcome. Data were collected from 65% (181/277) of eligible participants. A total of 98% (175) of participants had positive views about their participation. Some exposures, including cigarette smoking, supine sleep position and reduced fetal movements were less frequent in twin pregnancies compared to singletons, whereas fertility treatment was more common. Furthermore, different patterns of exposure were seen between monochorionic and dichorionic twins. This pilot study found some associations with adverse neonatal outcomes including: low BMI (OR 8.36, 95% CI: 1.02-68.87), maternal age ≥41 years (OR 9.0 95% CI: 1.07-75.84), maternally perceived high-stress levels (OR 1.96, 95% CI: 1.03-3.75) and inadequate antenatal screening (OR 1.44, 95% CI: 1.01-2.06). Sleep duration ≥9 h and right-sided going to sleep position were more frequent among pregnancies with adverse outcomes. Participants who reported receiving no information on fetal movement and reduced maternal perception of movements were more likely to have an adverse outcome, but sample size prohibited analysis based upon chorionicity. An observational study of modifiable factors in twin pregnancy is feasible. Differences in the frequencies of exposures between twin and singleton pregnancies highlight the need for twin-specific studies to identify modifiable factors and develop preventative strategies for morbidity and mortality in twin pregnancies.

Prediction of Monochorionic Diamniotic Twin Pregnancy Outcomes Based on Early Second Trimester Ultrasound

Background: Association between second trimester ultrasound findings and twin pregnancy outcome is still unclear. Study aimed to evaluate the performance of second trimester ultrasound scan in the prediction of monochorionic diamniotic twin pregnancies outcomes. Methods: Prospective-cohort study of all consecutive healthy women with monochorionic twin pregnancies followed-up and delivered in five years was undertaken. During second trimester screening (16–18 weeks) fetal biometry was measured (biparietal diameter–BPD, abdominal circumference–AC, femur length–FL, estimated fetal weight–EFW) and inter-twin discordance noted. Amniotic fluid amount was determined. Pregnancy outcomes were having live-born twins, Apgar sores and birth-weights, pregnancy complications and gestational week of delivery. Results: Receiver operating characteristics (ROC) analysis showed that BPD (p = 0.018), AC (p = 0.019) and FL (p = 0.015) were good predictors of having live-born twins. Regression analysis showed that the most important factors influencing twins’ survival to term were inter-twin AC, BPD and FL differences. Fetal discordance in BPD, AC and FL explained correctly 76.3%, 76.5% and 58% of pregnancy outcomes. If second trimester inter-twin BPD difference was &lt;2.5 mm, AC difference was &lt;17 mm and FL difference was &lt;1.5 mm survival of twins was better, complications were less frequent, delivery mostly occurred closer to term, twins had higher birth-weights and better Apgar scores. Second trimester EFW of twin and its difference as well as the amniotic fluid amount were not associated with examined pregnancy outcomes. Conclusions: Discordant twins’ growth in the second trimester registered by ultrasound reliably implies on adverse monochorionic diamniotic twin pregnancy outcome.

Granulocyte colony-stimulating factor in assisted reproductive technology treatment does not increase the risk of adverse perinatal outcomes in twin pregnancies

The aim of the study is to compare the perinatal outcomes of twin pregnancies resulting from assisted reproductive technology (ART) treatment in which granulocyte colony-stimulating factor (G-CSF) was used with those in which it was not. In this retrospective study, the clinical data of 122 dichorionic diamniotic twin pregnancies were reviewed. Pregnancies were divided into two groups, G-CSF-treated and non-G-CSF treated. Maternal age, gestational week at birth, oligohydramnios, gestational hypertension, pre-eclampsia, preterm birth, first-trimester bleeding, gestational diabetes, rupture of membrane, foetal congenital anomalies, admission to the neonatal intensive care unit, birth weight (BW), small for gestational age, BW discordance, Apgar score and placental weight were compared between the groups. IMPACT STATEMENT What is already known on this subject? Granulocyte colony-stimulating factor (G-CSF) administrations increase pregnancy outcomes and do not have a negative effect on perinatal outcomes in singleton pregnancies. What the results of this study add? This study showed that the perinatal outcome of dichorionic diamniotic twin pregnancies conceived after assisted reproductive technology (ART) treatment was similar in the GSF administrated and non-GSF administrated groups. What the implications are of these findings for clinical practice and/or further research? Using G-CSF to increase the success of ART does not seem to have an adverse outcome in the dichorionic diamniotic twin pregnancies.

Open Questions on Gestational Diabetes Mellitus in Twin Pregnancies.

The concurrent, recent increase in prevalence of Gestational Diabetes Mellitus (GDM) and twin pregnancy, in combination with the shared risk factors, has led to speculation that multiples are a risk factor for GDM and, GDM may contribute to twin complications. Twin pregnancies have different physiology and greater obstetric risks compared to singletons, including prematurity and growth restriction. However, in twins methods of GDM screening, thresholds for diagnosis and treatment, as well as glycaemic control targets, have been predominantly extrapolated from singletons. Studies investigating the impact of GDM on pregnancy outcomes in twin pregnancies are conflicting. To provide a comprehensive, critical overview of evidence on GDM in twin pregnancies with an emphasis on prevalence, methods of screening, thresholds for diagnosis, risk of pregnancy complications and the impact of treatment on perinatal outcomes. Review of retrospective and prospective cohort, case-control, and case-series studies on twin pregnancies with GDM published between 1980 and 2021. Glucose tolerance in twin pregnancies is poorly studied. Specific guidance for screening, diagnosis, and treatment of GDM in twins is lacking. Studies evaluating pregnancy outcomes in twins with GDM are few and heterogeneous. The absolute risk of maternal complications is greater in twins with GDM compared to singletons; conversely, differences in risks between twins with and without GDM may be due to maternal confounders rather than to GDM. Most studies agree on a positive effect of GDM on neonatal outcomes in twins, likely mediated by the hyperglycaemia improving fetal growth. The impact of lifestyle-measures versus medical management on pregnancy outcomes in twins with GDM is unknown. Larger longitudinal studies evaluating glucose tolerance, pregnancy outcomes and the impact of treatment both in mono and di-chorionic twins with GDM are warranted to gain further insight into the pathophysiology of this condition and guide optimal management.

Impact of Gestational Diabetes and Hypertension Disorders of Pregnancy on Neonatal Outcomes in Twin Pregnancies Based on Chorionicity.

The objective of this study was to investigate the impact of the co-existence of gestational diabetes (GDM) and hypertension disorders of pregnancy (HDP) on neonatal outcomes in twin pregnancies based on chorionicity. A retrospective study of 1398 women with twin pregnancies was performed between January 2016 and December 2021. The effects of GDM and HDP on neonatal outcomes were assessed by logistic regression models. An additional stratified analysis was conducted to estimate the effects based on chorionicity (monochorionic (MC) and dichorionic (DC)). The incidence of the co-existence of GDM and HDP was 3.8%. The presence of GDM increased the likelihood of HDP only in women with MC twin pregnancies (OR, 2.13; 95% CI 1.08-4.19). After adjustments, co-existence of GDM and HDP was positively associated with gestational age (β, 1.06; 95% CI 0.43-1.69) and birthweight (β, 174.90; 95% CI 8.91-340.89) in MC twin pregnancies, while no associations were found between co-existence of GDM and HDP and neonatal outcomes in DC twin pregnancies. However, HDP was negatively associated with birthweight (β, -156.97; 95% CI (-257.92, -56.02)) and positively associated with small-for-gestational-age (SGA) (OR, 2.03; 95% CI 1.02-4.03) and discordant twins (OR, 2.83; 95% CI 1.78-4.48) in DC twin pregnant women without GDM. Our results suggested that GDM leads to an increased risk of HDP only in MC twin pregnancies, but GDM seemed to attenuate the adverse effects of HDP on perinatal outcomes in both MC and DC twin pregnancies. Further investigation is needed to explain these intriguing findings.

Fetomaternal Outcome in Twin Pregnancy

Fetomaternal Outcome in Twin Pregnancy

Maternal and neonatal outcomes of singleton versus twin pregnancies complicated by gestational diabetes mellitus: A systematic review and meta-analysis.

There is limited evidence exploring the maternal and neonatal complications of gestational diabetes mellitus (GDM) following singleton or twin pregnancies. Further, there have been no reviews completed examining the possible risk factors associated with GDM in singleton compared to twin pregnancies. This study assesses the impact of GDM in singleton and twin pregnancies on maternal and neonatal outcomes. From 1954 to December 2021, a thorough literature search was conducted in the EMBASE, Cochrane, MEDLINE, ScienceDirect, and Google Scholar databases and search engines. The risk of bias was calculated using the Newcastle Ottawa (NO) scale. A random-effects model was applied and interpreted as pooled odds ratio (OR) with 95% confidence intervals (CI). Eight studies satisfied the inclusion criteria, with the quality of most studies being good to satisfactory. The risk of caesarean section (pooled OR = 0.32; 95%CI: 0.22 to 0.46), small-for-gestational age (SGA) neonates (pooled OR = 0.40; 95%CI: 0.19 to 0.84), preterm delivery (pooled OR = 0.07; 95%CI: 0.06 to 0.09), respiratory morbidity (pooled OR = 0.26; 95%CI: 0.19 to 0.37), neonatal hyperbilirubinemia (pooled OR = 0.19; 95%CI: 0.10 to 0.40), and NICU admission (pooled OR = 0.18; 95%CI: 0.14 to 0.25) was significantly lower in singleton pregnancies with GDM than in twin pregnancies with GDM. Maternal outcomes like caesarean section and neonatal outcomes like SGA neonates, preterm delivery, respiratory morbidity, hyperbilirubinemia, and NICU admission were significantly greater in twin pregnancies with GDM. It is important for clinicians and policymakers to focus intervention strategies on twin pregnancies with GDM.

Factors influencing neonatal outcomes in twin pregnancies undergoing cesarean section: a cross-sectional study

This study aimed to evaluate maternal and fetal characteristics and factors affecting fetal outcomes in twin pregnancies delivered by cesarean section. This was a cross-sectional study in a tertiary care referral hospital. The primary outcome was to ascertain the effects of independent factors on the 1st and 5th minute APGAR scores, neonatal intensive care unit admissions, the need for mechanical ventilation, and neonatal mortality. A total of 453 pregnant women and 906 newborns were included in the analysis. The final logistic regression model revealed that early gestational weeks and neonates <3rd weight percentile at the time of delivery were the most significant predictors of all poor outcome parameters in at least one of the twins (p<0.05). General anesthesia for cesarean section was associated with 1st minute APGAR<7 and the need for mechanical ventilation, and emergency surgery was correlated with the need for mechanical ventilation (p<0.05) in at least one of the twins. General anesthesia, emergency surgery, early gestational weeks, and birth weight <3rd weight percentile were strongly associated with poor neonatal outcomes in at least one of the twins delivered by cesarean section.

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.

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.