Perinatal Outcomes In Twin Pregnancies Research Articles

Low PAPPA and Its Association with Adverse Pregnancy Outcomes in Twin Pregnancies: A Systematic Review of the Literature and Meta-Analysis

Background: It is well established in the literature that pregnancy-associated plasma protein-A (PAPP-A) is linked to several adverse pregnancy outcomes, including pre-eclampsia (PE), fetal growth restriction (FGR), and preterm birth (PTB) in singleton pregnancies. However, data regarding such an association in twin pregnancies are lacking. The primary goal of this systematic review and meta-analysis was to assess the potential value of low PAPP-A levels in the prediction of the subsequent development of hypertensive disorders of pregnancy (HDPs), PTB, and small for gestational age (SGA)/FGR fetuses in twin pregnancies and investigate its association with the development of gestational diabetes, intrauterine death (IUD) of at least one twin, and birth weight discordance (BWD) among the fetuses. Methods: Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar databases were systematically searched from inception until 31 July 2024. All observational studies reporting low PAPP-A levels after the performance of the first-trimester combined test as part of the screening for chromosomal abnormalities with reported adverse pregnancy outcomes were included. Results: The current systematic review encompassed a total of 11 studies (among which 6 were included in the current meta-analysis) that enrolled a total of 3741 patients. Low PAPP-A levels were not associated with HDPs (OR 1.25, 95% CI 0.78, 2.02, I-square test: 13%). Low PAPP-A levels were positively associated with both the development of preterm birth prior to 32 (OR 2.85, 95% CI 1.70, 4.77, I-square test: 0%) and 34 weeks of gestational age (OR 2.09, 95% CI 1.34, 3.28, I-square test: 0%). Furthermore, low PAPP-A levels were positively associated with SGA/FGR (OR 1.58, 95% CI 1.04, 2.41, I-square test: 0%). Prediction intervals indicated that the sample size that was used did not suffice to support these findings in future studies. Conclusions: Our study indicated that low PAPP-A levels are correlated with an increased incidence of adverse perinatal outcomes in twin pregnancies. Identifying women at elevated risk for such adversities in twin pregnancies may facilitate appropriate management and potential interventions, but additional studies are required to identify the underlying mechanism linking PAPP-A with those obstetrical complications.

Association between interpregnancy interval and adverse perinatal outcomes among subsequent twin pregnancies: a nationwide population-based study

BackgroundThe existing evidence on the association between interpregnancy interval (IPI) and pregnancy outcomes primarily focuses on singleton pregnancies, with limited research on twin pregnancies. ObjectiveThis study aimed to investigate the association between IPI and adverse perinatal outcomes in twin pregnancies. Study DesignThis population-based, retrospective cohort study analyzed data from the National Center for Health Statistics in the United States between 2016 and 2020. We included multiparous women aged 18 to 45 years with live-born twins without congenital anomalies, born between 26 and 42 weeks of gestation. Poisson regression models, adjusted for potential confounders, were used to evaluate the associations between IPI and adverse outcomes, including preterm birth (PTB) <36 weeks, small for gestational age (SGA), neonatal intensive care unit (NICU) admission, neonatal composite morbidity, and infant death. Missing data on covariates were managed using multiple imputations. Dose-response analyses were performed using the restricted cubic splines (RCS) approach. Subgroup analyses were stratified by maternal age, parity, and combination of neonatal sex. Sensitivity analyses were conducted using complete data and excluding pregnancies with intervening events during the IPI. ResultsA total of 143,014 twin pregnancies were included in the analysis. Compared to the referent group (IPI of 18–23 months), an IPI of less than 6 months was associated with an increased risk of PTB<36 weeks (RR, 1.21; 95% confidence interval [95% CI]: 1.17–1.25), SGA (RR, 1.11; 95% CI: 1.03–1.18), neonatal composite morbidity (RR, 1.19; 95% CI: 1.12–1.27), NICU admission (RR, 1.18; 95% CI: 1.14–1.22), and infant death (RR, 1.29; 95% CI: 1.05–1.60). An IPI of 5 years or more was associated with an increased risk of PTB<36 weeks (RR, 1.18; 95% CI: 1.15–1.21), SGA (RR, 1.24; 95% CI: 1.18–1.30), neonatal composite morbidity (RR, 1.10; 95% CI: 1.05–1.15), and NICU admission (RR, 1.14; 95% CI: 1.11–1.17). The dose-response analyses showed that these outcomes had U-shaped or J-shaped associations with IPI. The associations between IPI and the outcomes slightly differed by advanced maternal age, parity, and combination of neonatal sex. The sensitivity analyses yielded similar results to the main findings. ConclusionExtreme IPI, less than 6 months or more than 5 years, was associated with adverse outcomes in twin pregnancies. IPI could be used as a predictor for risk stratification in high-risk twin pregnancies.

Study on perinatal outcome in twin pregnancies at ESI-PGIMSR, ESIC Medical College &amp;amp; Hospital, Joka, Kolkata

Study on perinatal outcome in twin pregnancies at ESI-PGIMSR, ESIC Medical College &amp;amp; Hospital, Joka, Kolkata

Prevalence, Risk Factors, and Perinatal Outcomes of Velamentous Umbilical Cord Insertion in Twin Pregnancies: A Single-Center Retrospective Study.

The effect of velamentous cord insertion (VCI) on perinatal outcomes in twin pregnancies is unclear due to conflicting findings. This retrospective study aimed to examine VCI prevalence and related risk factors in twin pregnancies and its association with adverse perinatal outcomes. Women with twin pregnancies who delivered between January 2012 and December 2021 in a single tertiary hospital were included. The participants were divided into dichorionic (DC) and monochorionic diamniotic (MCDA) groups, and their maternal and fetal characteristics and VCI rates were compared. Logistic regression models were used to identify risk factors for VCI and VCI-related perinatal outcomes. Among the 694 twin pregnancies included in this study, the VCI rate was significantly higher in MCDA than in DC twins. Body mass index and MCDA twins were significant risk factors for VCI, whereas assisted reproductive technology pregnancy was a significant protective factor against VCI. In DC twins, VCI did not affect perinatal outcomes. In MCDA twins, VCI was a significant risk factor for fetal growth restriction, twin-to-twin transfusion syndrome, and preterm birth at <36 weeks. VCI was a prominent risk factor for adverse perinatal outcomes only in MCDA twins. Antenatal sonographic assessment of the umbilical cord insertion site would be beneficial.

Maternal and perinatal outcomes in twin pregnancies following assisted reproduction: a systematic review and meta-analysis involving 802462 pregnancies.

ART is associated with higher rates of twin pregnancies than singleton pregnancies. Whether twin pregnancies conceived following ART have additional maternal and neonatal complications compared with non-ART twin pregnancies is not known. The objective was to quantify the risk of adverse maternal and perinatal outcomes among twin pregnancies conceived following ART compared with non-ART and natural conception. Existing reviews vary in the reported outcomes, with many studies including triplet pregnancies in the study population. Therefore, we aimed to perform an up-to-date review with an in-depth analysis of maternal and perinatal outcomes limited to twin pregnancies. We searched electronic databases MEDLINE and EMBASE from January 1990 to May 2023 without language restrictions. All cohort studies reporting maternal and perinatal outcomes following ART compared with non-ART twin pregnancies and natural conception were included. Case-control studies, case reports, case series, animal studies, and in vitro studies were excluded. The Newcastle-Ottawa Scale was used to assess the methodological quality of the studies. Using random-effects meta-analysis, the estimates were pooled and the findings were reported as odds ratios (OR) with 95% CI. We included 111 studies (802462 pregnancies). Twin pregnancies conceived following ART were at higher risk of preterm birth at <34 weeks (OR 1.33, 95% CI 1.14-1.56, 29 studies, I2 = 73%), <37 weeks (OR 1.26, 95% CI 1.19-1.33, 70 studies, I2 = 76%), hypertensive disorders in pregnancy (OR 1.29, 95% CI 1.14-1.46, 59 studies, I2 = 87%), gestational diabetes mellitus (OR 1.61, 95% CI 1.48-1.75, 51 studies, I2 = 65%), and caesarean delivery (OR 1.80, 95% CI 1.65-1.97, 70 studies, I2 = 89%) compared with non-ART twins. The risks for the above maternal outcomes were also increased in the ART group compared with natural conception. Of the perinatal outcomes, ART twins were at significantly increased risk of congenital malformations (OR 1.17, 95% CI 1.05-1.30, 39 studies, I2 = 59%), birthweight discordance (>25% (OR 1.31, 95% CI 1.05-1.63, 7 studies, I2 = 0%)), respiratory distress syndrome (OR 1.32, 95% CI 1.09-1.60, 16 studies, I2 = 61%), and neonatal intensive care unit admission (OR 1.24, 95% CI 1.14-1.35, 32 studies, I2 = 87%) compared with non-ART twins. When comparing ART with natural conception, the risk of respiratory distress syndrome, intensive care admissions, and birthweight discordance >25% was higher among the ART group. Perinatal complications, such as stillbirth (OR 0.83, 95% CI 0.70-0.99, 33 studies, I2 = 49%), small for gestational age <10th centile (OR 0.90, 95% CI 0.85-0.95, 26 studies, I2 = 36%), and twin-twin transfusion syndrome (OR 0.45, 95% CI 0.25-0.82, 9 studies, I2 = 25%), were reduced in twin pregnancies conceived with ART versus those without ART. The above perinatal complications were also fewer amongst the ART group than natural conception. ART twin pregnancies are associated with higher maternal complications than non-ART pregnancies and natural conception, with varied perinatal outcomes. Women seeking ART should be counselled about the increased risks of ART twin pregnancies and should be closely monitored in pregnancy for complications. We recommend exercising caution when interpreting the study findings owing to the study's limitations.

Perinatal Outcome of Twin Pregnancies in Relation to Chorionicity at a Tertiary Care Centre in Central Kerala, India: A Prospective Cohort Study

Introduction: In recent years, there has been a significant increase in the incidence of multiple births due to advanced maternal age at conception and the growing use of infertility treatment. Multiple pregnancies are associated with both maternal and perinatal complications. Maternal complications include anaemia, gestational hypertension, gestational diabetes, preterm labour, operative delivery and postpartum haemorrhage. Preterm birth, growth discordance and complications specific to monochorionic twins predispose these babies to adverse perinatal outcomes. Aim: To assess the perinatal outcomes of twin pregnancies and compare the outcomes of monochorionic and dichorionic pregnancies. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College (Tertiary care centre), Thrissur, Kerala, India, from September 2019 to August 2020. All twins who delivered at a gestational age of ≥28 weeks during the study period were recruited, totaling 76 twin pregnancies. A structured proforma was used to collect demographic and clinical details, including mode of conception, chorionicity, maternal complications, intrapartum events and neonatal outcomes. Data were analysed using Epi Info software. Results: The mean maternal age of the study participants was 28.39±6.29 years. The incidence of twin pregnancies delivering at ≥28 weeks at Government Medical College, Thrissur, during the study period was 2.8% (76 twins out of 2709 deliveries). Infertility treatment (ovulation induction alone or Assisted Reproductive Techniques (ART) was associated with dichorionic twinning in 19.7% (15 out of 76 twin pregnancies), with a p-value of 0.008. Maternal complications were similar in both dichorionic and monochorionic twins. Preterm Premature Rupture of Membranes (PPROM) occurred in 23 (28.75%) twin pregnancies, 19 (23.75%) had Gestational Diabetes Mellitus while 13 (16.25%) participants had anaemia. Foetal growth restriction, congenital anomalies, and discordant growth were more prevalent in monochorionic twin pregnancies compared to dichorionic twin pregnancies. Although the proportion of babies requiring Neonatal Intensive Care Unit (NICU) admission was higher in monochorionic twins (64% vs 53.9%), the proportion of neonatal deaths was nearly equal between monochorionic and dichorionic twins (10% vs 9.8%). Conclusion: In the present study, there was no statistical difference in maternal complications between monochorionic and dichorionic twins. However, monochorionic pregnancies had a poorer perinatal outcome compared to dichorionic pregnancies.

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.

Maternal and neonatal outcomes of twin pregnancies complicated by gestational diabetes mellitus

IntroductionGestational diabetes mellitus (GDM) is associated with a higher risk of adverse maternal outcomes, but its effects on maternal and perinatal outcomes of twin pregnancies remain conflicting.MethodsThis retrospective cohort study included all primipara who delivered twin pregnancies at a single tertiary perinatal center between January 1, 2016 and December 31, 2022. Excluded were those who had a single pregnancy, twin pregnancies with pre-existing diabetes, missing information on GDM screening, a delivery before gestational 28 weeks, complications related to monochorionic placentation, multifetal reduction, fetal anomalies, and monochorionic monoamniotic twins. Maternal outcomes included preterm birth, pre-eclampsia, hypothyroidism, preterm premature rupture of membranes (PROM), placental abruption, severe postpartum hemorrhage, and oligohydramnios. Neonatal outcomes included small-for-gestational-age (SGA), large-for-gestational-age (LGA), birthweight, Apgar score, neonatal intensive care unit (NICU) admission, extrauterine growth restriction (EUGR), and neonatal hypoglycemia.ResultsA total of 3269 twins were delivered, with 897 women (27.4%) diagnosed with GDM during pregnancies; moreover, 72 (8.0%) of these women received insulin treatment. The GDM group showed a significantly higher maternal age at delivery (≥35 years), as well as incidences of overweight and obesity. These factors also elevated the odds of insulin treatment in GDM women with twin pregnancies (OR = 1.881, 95% CI = 1.073–3.295, P = 0.027; OR = 2.450, 95% CI = 1.422–4.223, P < 0.001; OR = 4.056, 95% CI = 1.728–9.522, P < 0.001, respectively). Chronic hypertension prior to pregnancy was identified as a risk factor for GDM during twin pregnancies (OR = 1.896, 95% CI = 1.290–2.785, P < 0.001), although it did not increase the proportion of women requiring insulin treatment (P = 0.808). Aside from a higher incidence of preterm birth before 37 weeks in insulin-treated GDM twins (OR = 2.096, 95% CI = 1.017–4.321, P = 0.045), there were no significant difference in other maternal outcomes (preterm birth before 34 weeks, pre-eclampsia, hypothyroidism, PROM, placental abruption, placenta previa, severe postpartum hemorrhage, and oligohydramnios) between the GDM group and non-GDM group, and between insulin-treated GDM and non-insulin-treated GDM. The rate of newborns with birthweight <1500 g was significantly lower among twins born to GDM women, but the prevalence of EUGR was notably higher. Additionally, the risk of EUGR was elevated in insulin-treated GDM twins (OR = 3.170, 95% CI = 1.639,6.131, P < 0.001). No significant differences were observed between the GDM group and non-GDM group, or between insulin-treated GDM and non-insulin-treated GDM group in terms of mean birthweight, newborn sex ratio, and incidences of other adverse neonatal outcomes, including gestational age at delivery, LGA, birth weight <2500 g, and 1-min and 5-min Apgar scores.ConclusionMaternal age ≥35 years, overweight or obesity, and chronic hypertension are significant risk factors for GDM during twin pregnancies. Women with GDM during twin pregnancies may achieve similar outcomes compared to those without GDM. However, the women with GDM during twin pregnancies receiving insulin therapy may have a higher risk of preterm birth and EUGR.

Different subtypes of gestational diabetes mellitus are associated with distinct perinatal outcomes in twin pregnancies

AimsTo determine whether different gestational diabetes mellitus (GDM) subtypes are associated with distinct perinatal outcomes in twin pregnancies. MaterialsThis retrospective cohort study enrolled women with twin pregnancies who gave birth at a tertiary hospital between January 2017 and December 2022. GDM was diagnosed by the IADPSG diagnostic criteria. Three subtypes of GDM were defined as only abnormal fasting glucose (OAFG) values, only abnormal post-load glucose (OAPG) values and abnormal combined fasting and post-load glucose (ACFPG) values. Logistic regression or generalized estimation equation models were used to test the correlation of subtypes of GDM and perinatal outcomes. ResultsGDM with OAPG had a slightly higher risk for preterm delivery (PTD) at <37 gestational weeks (aOR 1.22, 95 %CI 1.01–1.47) and neonatalintensivecareunit (NICU) admission (aOR 1.31, 95 %CI 1.09–1.57). GDM with ACFPG were associated with PTD at <37 gestational weeks (aOR 1.42, 95 %CI 1.06–1.89) and PTD at <34 gestational weeks (aOR 1.65, 95 % CI 1.14–2.39). GDM with OAFG had a lower risk of being small-for-gestational age (SGA) (aOR 0.48, 95 % CI 0.26–0.92). ConclusionsDifferent subtypes of GDM are associated with distinct perinatal outcomes. Only abnormal fasting glucose levels may be responsible for reduced the risk of SGA neonates.

Associations between velamentous or marginal cord insertion and risk of adverse perinatal outcomes in twin pregnancies: a retrospective cohort study

BackgroundVelamentous cord insertion (VCI) and marginal cord insertion (MCI) are well-known risk factors for adverse perinatal outcomes in singleton pregnancies. However, the potential links between VCI or MCI and perinatal outcomes in twin pregnancies have yet to be systematically evaluated. This study aimed to investigate the relationships between VCI or MCI and perinatal outcomes in twin pregnancies.MethodsThis retrospective single-center cohort study included women with twin pregnancies who gave birth in a tertiary hospital in Southwest, China between January 2017 and December 2022. VCI and MCI were identified by abdominal ultrasound and confirmed after placental delivery. Logistic regression, multinomial logit regression and generalized estimation equation models were used to evaluate the association between VCI or MCI and perinatal outcomes.ResultsA total of 3682 twin pregnancies were included, including 100 (2.7%) pregnancies with VCI and 149 (4.0%) pregnancies with MCI. Compared to pregnancies with normal cord insertion, both monochorionic and dichorionic pregnancies with VCI were associated with an increased risk of preterm delivery 32–34 weeks (aRRR 2.94, 95% CI 1.03–8.39; aRRR 2.55, 95% CI 1.19–5.46, respectively), while pregnancies with MCI were not associated with preterm delivery. VCI was associated with a higher incidence of placental previa (aOR 6.36, 95% CI 1.92–21.04) in monochorionic pregnancies and placental accreta (aOR 1.85, 95% CI 1.06–3.23) in dichorionic pregnancies. MCI was associated with an increased risk of preeclampsia (aOR 3.07, 95% CI 1.49–6.32), intertwin birthweight discordance ≥ 20% (aOR 2.40, 95% CI 1.08–5.60) and selective fetal growth restriction (aOR 2.46, 95% CI 1.08–5.60) in monochorionic pregnancies and small-for-gestational age neonates (aOR 1.97, 95% CI 1.24–3.14) in dichorionic pregnancies.ConclusionsVCI was associated with an increased risk of preterm delivery in twin pregnancies irrespective of chorionicity, whereas MCI was associated with an increased preeclampsia risk, significant intertwin birthweight discordance in monochorionic pregnancies and small-for-gestational age neonates in dichorionic pregnancies.

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.

Cervical cerclage for prevention of preterm birth and adverse perinatal outcome in twin pregnancies with short cervical length or cervical dilatation: A systematic review and meta-analysis.

The optimal approach to prevent preterm birth (PTB) in twins has not been fully established yet. Recent evidence suggests that placement of cervical cerclage in twin pregnancies with short cervical length at ultrasound or cervical dilatation at physical examination might be associated with a reduced risk of PTB. However, such evidence is based mainly on small studies thus questioning the robustness of these findings. The aim of this systematic review was to determine the role of cervical cerclage in preventing PTB and adverse maternal or perinatal outcomes in twin pregnancies. Key databases searched and date of last search: MEDLINE, Embase, and CINAHL were searched electronically on 20 April 2023. Eligibility criteria: Inclusion criteria were observational studies assessing the risk of PTB among twin pregnancies undergoing cerclage versus no cerclage and randomized trials in which twin pregnancies were allocated to cerclage for the prevention of PTB or to a control group (e.g., placebo or treatment as usual). The primary outcome was PTB <34 weeks of gestation. The secondary outcomes were PTB <37, 32, 28, 24 weeks of gestation, gestational age at birth, the interval between diagnosis and birth, preterm prelabor rupture of the membranes (pPROM), chorioamnionitis, perinatal loss, and perinatal morbidity. Subgroup analyses according to the indication for cerclage (short cervical length or cervical dilatation) were also performed. Risk of bias assessment: The risk of bias of the included randomized controlled trials (RCTs) was assessed using the Revised Cochrane risk-of-bias tool for randomized trials, while that of the observational studies using the Newcastle-Ottawa scale (NOS). Statistical analysis: Summary risk ratios (RRs) of the likelihood of detecting each categorical outcome in exposed versus unexposed women, and (b) summary mean differences (MDs) between exposed and unexposed women (for each continuous outcome), with their 95% confidence intervals (CIs) were computed using head-to-head meta-analyses. Synthesis of the results: Eighteen studies (1,465 twin pregnancies) were included. Placement of cervical cerclage in women with a twin pregnancy with a short cervix at ultrasound or cervical dilatation at physical examination was associated with a reduced risk of PTB <34 weeks of gestation (RR: 0.73, 95% CI [0.59, 0.91], p = 0.005 corresponding to a 16% difference in the absolute risk, AR), <32 (RR: 0.69, 95% CI [0.57, 0.84], p < 0.001; AR: 16.92%), <28 (RR: 0.54, 95% [CI 0.43, 0.67], 0.001; AR: 18.29%), and <24 (RR: 0.48, 95% CI [0.23, 0.97], p = 0.04; AR: 15.57%) weeks of gestation and a prolonged gestational age at birth (MD: 2.32 weeks, 95% [CI 0.99, 3.66], p < 0.001). Cerclage in twin pregnancy with short cervical length or cervical dilatation was also associated with a reduced risk of perinatal loss (RR: 0.38, 95% CI [0.25, 0.60], p < 0.001; AR: 19.62%) and composite adverse outcome (RR: 0.69, 95% CI [0.53, 0.90], p = 0.007; AR: 11.75%). Cervical cerclage was associated with a reduced risk of PTB <34 weeks both in women with cervical length <15 mm (RR: 0.74, 95% CI [0.58, 0.95], p = 0.02; AR: 29.17%) and in those with cervical dilatation (RR: 0.68, 95% CI [0.57, 0.80], p < 0.001; AR: 35.02%). The association between cerclage and prevention of PTB and adverse perinatal outcomes was exclusively due to the inclusion of observational studies. The quality of retrieved evidence at GRADE assessment was low. Emergency cerclage for cervical dilation or short cervical length <15 mm may be potentially associated with a reduction in PTB and improved perinatal outcomes. However, these findings are mainly based upon observational studies and require confirmation in large and adequately powered RCTs.

Perinatal Outcome in Twin Pregnancy According to Chorionicity

Background: Multiple pregnancy is defined as pregnancy with 2 or more fetuses. It is termed as twins for 2 fetuses, triplets for 3 fetuses, Quadruplets for 4 fetuses, Quintuplets for 5 fetuses, Sextuplets for 6 fetuses and Septuplets for 7 fetuses and so on. The incidence of multiple pregnancies varies significantly. In several overview studies (since the early 1970) it was found that natural twinning rates were less than 8 twin births per 1000 births in East Asia and Oceania, 9-16 per 1000 births in Europe, USA and India and 17 and more per 1000 births in African countries. Methods: This prospective observational study was conducted by the department of OBG at Sri muthukumaran medical college hospital and research institute, Shikkarayapuram, Chennai from December 2019 to May 2020. Results: Primigravidas constituted for 43% of pregnancies and multigravidas constituted for 57% of pregnancies. The maximum cases 42 (42%) were in the age of 25-29 yrs followed by 31(31%) in the age group 21-24 years. The mean age of the patients was 26.87 (SD 9.67) years. The discordant growth constituted for 12% of pregnancies in both monochorionic and dichorionic twins where as it was absent in 88% of cases.

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.

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.

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.

Aspirin for prevention of preeclampsia and adverse perinatal outcome in twin pregnancies: a systematic review and meta-analysis

Aspirin for prevention of preeclampsia and adverse perinatal outcome in twin pregnancies: a systematic review and meta-analysis

Perinatal outcomes of twin pregnancies complicated with preeclampsia at a tertiary hospital in Ethiopia: A case‐control study

AbstractBackgroundPreeclampsia accounts for 10–15% maternal deaths globally, corresponding to 50,000 annual maternal deaths. Twin pregnancy is a known risk factor for preeclampsia; however, there is inadequate data on the clinical characteristics and perinatal outcomes of twin pregnancies complicated with preeclampsia. This paper studied the perinatal outcomes of twin pregnancies complicated with preeclampsia at a tertiary hospital in Ethiopia.MethodsA case‐control study was conducted at St. Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia) from September 1, 2016 till August 31, 2018. A total of 173 twin deliveries (63 preeclampsia cases and 110 normotensive controls) were included in the study and the primary outcome was the frequency of preterm delivery. Data were analyzed using SPSS version 23 and statistical test of association was done using chi‐square test for categorical data. Variables with p value of &lt;0.2 on bivariate analysis were entered into multivariable logistic regression analysis. p value &lt;0.05 were considered significant.ResultsThe frequency of preterm birth was 61.9% in the preeclampsia group and 33.6% in the normotensive group, p &lt; 0.001. Preeclampsia group were 2.58 times more likely to have preterm delivery compared to matched normotensive controls [adjusted OR = 2.58, 95% CI (1.24 – 5.35), p = 0.01]. There was no difference in the rate of adverse neonatal outcome (respiratory distress syndrome, early neonatal death, and Low Apgar score) between the groups.ConclusionsIn this study, twin pregnancies complicated with preeclampsia were found to have an increased rate of preterm birth compared to matched controls without hypertension.

Perinatal outcomes associated with ICP in twin pregnancies were worse than singletons: an almost 5-year retrospective cohort study

BackgroundIntrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse perinatal outcomes leading to high perinatal morbidity and mortality. However, few studies have examined twin pregnancies complicated by ICP. To assess the perinatal outcomes of twin pregnancies with ICP, a retrospective cohort study was conducted.MethodsA total of 633 twin pregnancies and 1267 singleton pregnancies with ICP were included. In addition, a correlation study was performed on the matched total bile acid (TBA) levels from maternal serum, fetal umbilical venous blood, and amniotic fluid of 33 twin pregnancies from twin groups.ResultsWhen compared to singletons, twin pregnancies with ICP had a higher risk of cesarean section (CS) (96.4% vs. 76.1%), preterm birth (PTB) (82.6% vs. 19.7%), fetal distress (2.0% vs. 1.3%), and neonatal intensive care unit (NICU) admission (23.6% vs. 5.1%), which was significantly related to increasing TBA levels (P < 0.05). In twin pregnancies with TBA ≥100 μmol/L, the incidences of CS, PTB, fetal distress, neonatal asphyxia, and meconium-stained amniotic fluid were 94.4, 100, 11.1, 5.6, and 36.1%, respectively. Furthermore, the maximum maternal TBA levels were positively correlated with TBA levels in the amniotic fluid (r = 0.61, P < 0.05) and umbilical cord blood (r = 0.44, P < 0.05), and a similar correlation was found for maternal TBA levels at delivery. TBA levels in umbilical cord blood and amniotic fluid also had a significant and positive correlation (r = 0.52, P < 0.05).ConclusionsTwin pregnancies with ICP had a higher risk for adverse perinatal outcomes than singletons, which was associated with higher TBA levels. TBA can be transported through the placenta and is involved in uterus-placenta-fetal circulation.

Discordance in twins: Association versus prediction.

Weight discordance is among the major determinants of perinatal outcome in twin pregnancies. Weight discordance can occur in each trimester of pregnancy, though the clinical meaning of such finding and the association with adverse perinatal outcome can vary according to the gestational age (GA) at detection of growth discrepancy. Discrepancy in fetal size in the first trimester of pregnancy is associated with an increased risk of anomalies, aneuploidy, and fetal loss, though the predictive accuracy of using discordance to predict perinatal outcome is low. Conversely, discordance in the third trimester of pregnancy can be associated with fetal growth restriction, perinatal mortality, and morbidity. In view of these associations, twin pregnancies should be monitored for the occurrence of growth discrepancy. The present review aims to provide an up-to-date critical appraisal of the diagnosis and clinical management of twin pregnancies complicated by growth discordance according to the trimester at presentation.