Prognosis Of Pregnancy Research Articles

Features of prenatal diagnostics of trisomy 9 in the first trimester of pregnancy

We report about 4 cases of prenatal diagnostics of mosaic trisomy 9 in the first trimester of pregnancy. The data of ultrasound, cytogenetic and pathoanatomical studies are presented. Prenatal diagnosis of trisomy 9 is difficult due to the non-specificity of the anomalies characteristic of it. Trisomy 9 in complete or mosaic form in chorionic villus cells may not be confirmed in the fetal tissues. Interpreting the results of cytogenetic analysis of chorionic villus cells and deciding on the prognosis of pregnancy with trisomy 9, the whole complex of clinical data should be taken into account: the results of the ultrasound examination and additional cytogenetic studies, anamnesis

Predictors of the development of placental dysfunction and methods for its correction in patients with retrochoric hematoma in the I trimester of gestation

The objective of study was to determine the predictors of the development of placental dysfunction and to develop methods for its prevention and treatment in patients with retrochoric hematoma in the first trimester of gestation.Patients and methods. Under observation, there were 58 pregnant women with retrochoric hematoma in the first trimester (main group) and 20 women with a physiological pregnancy (control group). All pregnant women underwent a standard clinical and laboratory examination. In the ultrasound study, the volume of the retrochoric hematoma, its localization, and also the coccygeal-parietal size of the embryo, the heart rate, the volume of the fetal egg, the mid-inner diameter of the yolk sac, the vascularization of the yellow body, the hemodynamics in the myometrium were assessed. In a transvaginal ultrasound study, a special three-dimensional VOCAL program was used to calculate the chorion volume and evaluate its vascular system.Results. Predictors of placental dysfunction in the detachment of the chorion in the I trimester of gestation are associated not only with the volume and localization of the retrochoric hematoma, but also, first of all, with the state of extraembryonic structures.Decreased vascularization of the chorion, its hypoplasia, pathological nature of the blood flow in the yellow body, and hemodynamic disturbances in the myometrium creates high risks of placental dysfunction and worsens the pregnancy prognosis. The developed preventive measures include the 3 stage of treatment, the medicament means are aimed not only at halting the bleeding, but also on the effective restoration of microcirculation and the provision of adequate conditions for the passage of the second wave of trophoblast invasion.Conclusion. The proposed three-step corrective therapy contributes to the normalization of uterine-chorionic blood flow, the restoration of effective embryochorial interrelations and significantly reduces the incidence of placental dysfunction in the future.

Comparison between maternal and neonatal outcome of PPROM in the cases of amniotic fluid index (AFI) of more and less than 5 cm

The study was performed on pregnant women with a gestational age of 26–32 weeks of pregnancy, who had been admitted to the hospital with a confirmed diagnosis of premature rupture of membranes. In all eligible women, ultrasounds were performed for the evaluation of amniotic fluid index. Then, the women were divided into two groups according to amniotic fluid index of ≥5 cm and <5 cm. These women were followed and monitored up to delivery. The women of the two groups did not have significant difference between them according to age, gestational age at the time of ruptured membrane, body mass index, gravidity, parity, gestational age at delivery and route of delivery. Maternal morbidities including chorioamnionitis, placental abruption, uterine atony after delivery and retention of placenta did not show significant difference between the two groups. There was no significant difference between the two groups’ amniotic fluid index <5 cm and amniotic fluid index ≥5 cm, regarding neonatal morbidities, except for neonatal sepsis and neonatal death, which were higher in the amniotic fluid index <5 cm group [7(14.6%) versus 1(2.3%), p = .039, RR = 7.7 (95%CI 0.04–0.06) and 11(30.9%) versus 2(4.7%), p = .013, RR = 6.095 (95%CI = 1.26–29.31)]. In the subgroups of two categories of gestational ages of 260–296 and 300–346, neonatal morbidities were higher in the amniotic fluid index <5 cm group. The results suggest that amniotic fluid index <5 cm should be considered as a warning sign for predicting poor prognosis of pregnancy complicated by preterm premature rupture of membranes.Impact statementWhat is already known on this subject? In a retrospective study in 1993, the relationship between oligohydramnios (which was defined as the largest single packet of fluid less than 2 × 2 cm) at the time of hospital admission, and the outcome of mother, foetus and neonates in a gestational age of less than 35 weeks of pregnancy was evaluated. In the oligohydramnios group, chorioamnionitis and funistis were more common. Also, the mean gestational age at the time of delivery and neonatal weight was less than that of the normal amniotic fluid group. According to these results, it was concluded that a low amniotic fluid volume in the women with preterm premature rupture of membranes (PPROM) can be considered as a prognostic factor in the cases of conservative management of PPROM. In contrast, the other study, which was performed on a larger sample size (290 patients), could not show more cases of amnionitis in the cases of amniotic fluid index (AFI) of less than 5 cm; however, the latency period was shorter in comparison with AFI of more than 5 cm.What do the results of this study add? Chorioamnionitis, placental abruption and uterine atony after delivery, retention of placenta and route of delivery did not show a significant difference between the two groups. Respiratory distress syndrome (RDS), need of surfactant and intubation, intra ventricular haemorrhage (IVH) and duration of neonatal intensive care unit (NICU) admission did not show a significant difference between the two groups; however, the rate of neonatal sepsis and neonatal death were higher in the AFI <5 cm group.What are the implications of these findings for clinical practice and/or further research? The results suggest that AFI <5 cm should be considered as a warning sign for predicting poor prognosis of pregnancy complicated by PPROM.

Morphological Survey of Placenta in Trombophilia Related Hypoperfusion of Maternal-Fetal Blood Flow.

ABSTRACT: Complex and modern obstetric medical care provides a constant improvement for the pregnancy prognosis. Thus, young women with an undiagnosed pathology become pregnant and, during pregnancy, the previously undiagnosed pathology, without any clinical signs and symptoms, becomes present during pregnancy, having an unfavorable impact on the fetus and the health state of the pregnant woman. The gestational syndromes during pregnancy influence the woman’s health state over a long period of time and the quality of the conception product. The recommendation, performance of laboratory tests and imagistic investigations at the right time during pregnancy, as well as a correct interpretation of their results, may prevent the onset of catastrophic occurrences including fetal death in utero and/ or maternal death. We report the case of a 30-year old primigesta, primipara (IGIP) patient with a singleton, naturally obtained pregnancy, severe preeclampsia, severe IUGR and thrombophilia.

Recurrent Risk of Preterm Birth in the Third Pregnancy in Korea.

BackgroundAlthough preterm delivery is the most common cause of infant morbidity and mortality, an obvious cause cannot be found in most cases. Preterm delivery is known to be the most important risk factor for preterm birth in a subsequent pregnancy. We aimed to evaluate the recurrence rate of premature births for subsequent pregnancies in women with a history of a preterm birth.MethodsStudy data were collected from the Korea National Health Insurance (KNHI) claims database and data from a national health-screening program for infants and children. We enrolled women who had their first delivery between January 1, 2007 and December 31, 2007 and a subsequent delivery before 2014.ResultsPreterm delivery had a significant higher risk of preterm birth in a subsequent singleton pregnancy. The risk of preterm birth at second pregnancy was 2.2% in women whose first delivery at ≥ 37 weeks and 18.6% in women whose first delivery at < 37 weeks (relative risks [RR], 8.64; 95% confidence interval [CI], 7.94–9.40). In the analysis of the third pregnancy, we compared women with an initial term birth followed by preterm birth and women with an initial preterm birth followed by a subsequent term birth. A history of a just preceding preterm birth at < 37 weeks was the most relevant factor for recurrence of preterm delivery in a subsequent pregnancy (26.6%, RR, 4.01; 95% CI, 2.45–6.58).ConclusionWe found that the prognosis of a third pregnancy was more closely related to the outcome of the second pregnancy to that of the first pregnancy.

Study of 41 Cases of Pregnancy after Uterine Leiomyoma Treatment by Uterine Artery Embolization (UAE)

Uterine leiomyoma, a benign tumor, may be treated with hormone therapy, conventional surgical resection and uterine artery embolization (UAE): this paper reports the study on safety after UAE treatment. Pregnancy processes and prognoses of a total of 41 cases from 39 patients (two women were pregnant twice) who succeeded to pregnancy after UAE treatment in our clinic were studied. The average age of patients was 34.5 (29 - 40). Patients included 24 cases of multiple uterine leiomyoma and 14 cases of solitary leiomyoma; the average size of leiomyoma was 388.3 cm3 (15 - 1059 cm3) and the average period between UAE operation and pregnancy was 26.5 months (1 - 120). Causes of pregnancy were 29 cases of natural pregnancy and 12 cases of infertility treatment: 28 cases succeeded in delivery, 7 cases resulted in spontaneous abortion, and 6 cases are ongoing. Premature birth, placental abnormality and low-weight babies were observed in 3, 3, and 1 cases, respectively; the latter 1 case was of triplets. Although the incidence of placental abnormality was a little high, no other serious complications were observed, suggesting that pregnancy after UAE has no problem from the obstetric point of view. In the future, UAE is considered to be worthwhile if carefully done for cases who want to become pregnant.

Prognosis of pregnancies complicated with arrhythmia in Morocco

An increasing number of women are delaying pregnancy until later in life, enhancing their risk of developing arrhythmias as the incidence of heart disease increases with age. It is retrospective, spread over 15 years, between January 2000 and December 2015,conducted in maternal intensive unit care, of the university hospital center Ibn Rochd Casablanca, Morocco. Were included: every pregnant woman who was admitted for a decompensated heart failure, a cardiogenic shock complicated with arrhythmias, or isolated arrhythmia; in women not known as heart disease carrier and/or in women known with heart disease. Eighty pregnant women were admitted in maternal intensive unit care, for arrhythmia during pregnancy. The average age was 32, 77 ± 6, 74,the medical story of rheumatic fever was frequently found (75%), and 80% of women in labor were followed for rheumatic valve disease. A total of 38.7% were followed by a cardiologist, while 23.7% of heart disease had been discovered only during pregnancy. Also, 66.2% of the pregnancies were not followed by an obstetrician. Symptoms were dominated by dyspnea (97, 5%) and palpitations (85%). The types of arrhythmia are: supraventricular tachyarrhythmia in 80%,ventricular tachycardia in 6.25%,ventricular fibrillation in 6%, and premature atrial complex in 7.75%. The mean fraction ejection is 43.48 ± 8.02; the most frequent valvular heart disease is mitral stenosis in 43%, followed by peripartum cardiomyopathy in 15%. Thirty percent of patients had an atrial fibrillation, 0.3% were treated by an antiarrhythmic agent, and 25% was on anticoagulants and anthrombotic agents. Twenty-two percent were complicated by thromboembolic complications as pulmonary embolism (8 cases), vein thrombosis of the lower limb (8 cases), and ischemic stroke in 2 cases. A cardiogenic shock has occurred in 21.21%, and pulmonary edema in 45% and 3.75% had a cardiac arrest after a ventricular fibrillation.

The effect of single balloon catheter on the outcome of pregnancy and neonatal prognosis

Objective To explore the effect of single balloon catheter on labor and neonatal outcomes of term pregnancy maternal. Methods A total of 104 full-term pregnancy pregnant women, who were induced labor in our hospital from January 2015 to December 2015, were selected as research objects, all of them were divided into control group and observation group, 52 cases of each group.Control group received induction of labor with intravenous infusion of oxytocin, and observation group was induction of labor with single balloon catheter.The effect of stimulating cervical maturity, Bishop score of cervical before and after induction of labor, stage of labor and neonate outcomes were compared between the two groups. Results The effective rate of cervical maturity was significantly higher in the observation group (98.1%)than in the control group(75.0%). The difference was statistically significant(P 0.05). Conclusions The implementation of single balloon catheter on full-term pregnancy pregnant women in cervical ripening is significantly effective, it can significantly reduce the stage of labor of full-term pregnancy pregnant women, and improve pregnancy outcomes. Key words: Single balloon catheter; Full-term pregnancy; Stage of labor; Cervical ripening; Maternal and neonatal outcomes

Abnormal human chorionic gonadotropin (hCG) trends after transfer of multiple embryos resulting in viable singleton pregnancies.

The purpose of this study is to investigate whether abnormal hCG trends occur at a higher incidence among women conceiving singleton pregnancies following transfer of multiple (two or more) embryos (MET), as compared to those having a single embryo transfer (SET). Retrospective cohort study was performed of women who conceived singleton pregnancies following fresh or frozen autologous IVF/ICSI cycles with day 3 or day 5 embryo transfers between 2007 and 2014 at a single academic medical center. Cycles resulting in one gestational sac on ultrasound followed by singleton live birth beyond 24weeks of gestation were included. Logistic regression models adjusted a priori for patient age at oocyte retrieval and day of embryo transfer were used to estimate the Odds Ratio of having an abnormal hCG rise (defined as a rise or < 66% in 2days) following SET as compared to MET. Among patients receiving two or more embryos, 6.1% (n = 84) had abnormal hCG rises between the first and second measurements, compared to 2.7% (n = 17) of patients undergoing SET (OR 2.16, 95% CI 1.26-3.71). Among patients with initially abnormal hCG rises who had a third level checked (89%), three-quarters had normal hCG rises between the second and third measurements. Patients who deliver singletons following MET were more likely to have suboptimal initial hCG rises, potentially due to transient implantation of other non-viable embryo(s). While useful for counseling, these findings should not change standard management of abnormal hCG rises following IVF. The third hCG measurements may clarify pregnancy prognosis.

Is There an Association Between Early Pregnancy Losses and Low 25-Hydroxy Vitamin D Levels?

Objective: Since the etiology of pregnancy losses during first trimester has not still been clear, we aim to analyze the relationship between vitamin D deficiency and early pregnancy losses. Patients and Methods: The study was conducted on 200 women. Plasma was collected from 100 nulliparous women with singleton at 7-10 weeks of gestation (50 with viable gestation and 50 with pregnancy loss) and 100 non-gravid reproductive age women (50 with a successful pregnancy history and 50 with one or more spontaneous first trimester pregnancy loss history). Serum 25 (OH) D and calcium levels were compared between groups. Results: The serum 25(OH) D levels for the groups turned out to be 47.64 ± 3.2 (95% CI: 44.4-50.8 ng/ml) for normal pregnancy group, 27.3 ± 1.2 (95% CI: 26.1-28.5 ng/ml) for the group of early pregnancy loss, 38.5 ± 5.1 (95% CI: 33.4-43.6 ng/ml) for the non gravid women with healthy pregnancy history and 11.6 ± 4.2 (95% CI: 7.9 - 15.6 ng/ml) for the non-gravid women with history of 1 or more first trimester pregnancy loss. There was a strong correlation between low 25(OH) D levels and early pregnancy loss (odds ratio (OR): 1.70, 95% CI: 1.2-2.3, p &lt;0.001). The calcium levels were significantly lower in pregnancy loss group than normal pregnancy and non-gravid groups (p=0.005, p=0.033 respectively). Conclusions: Although our study is emphasized on role of vitamin D in early pregnancy it is not possible to recommend screening and supplementation of vitamin D in early pregnancy, as prognosis of pregnancies receiving supplementation and the incidence of pregnancy related complications in follow-up are not known. Well designed studies with long term follow up results needed. Keywords: 25 hydroxy vitamin D, Pregnancy loss, 25 (OH) D vitamin

ОСОБЛИВОСТІ ПЕРЕБІГУ ГЕСТАЦІЇ У ЖІНОК ІЗ ГІПЕРТЕНЗИВНИМИ РОЗЛАДАМИ (РЕТРОСПЕКТИВНИЙ АНАЛІЗ)

Недостатня ефективність існуючих методів лікування гіпертензивних станів під час вагітності обґрунтовує доцільність пошуку нових антигіпертензивних засобів та методик їх застосування у вагітних, що дозволить попередити розвиток прееклампсії та еклампсії у значної кількості випадків, і, таким чином, знизити частоту розвитку ускладнень вагітності та перинатальних втрат.Мета дослідження – виявити фактори, що впливають на розвиток прееклампсії у вагітних з різними видами гіпертензивних розладів.Матеріали і методи. Проведено ретроспективний аналіз і багатопланову розробку 564 карт спостереження за вагітними та жінками з гіпертензивними розладами.Результати досліджень та їх обговорення. Хронічну артеріальну гіпертензію під час вагітності слід розглядати як один із факторів ризику виникнення прееклампсії та поєднаного гестозу, а низьку ефективність антигіпертензивної терапії або відсутність комплаєнсу можна вважати передвісником розвитку цих ускладнень. Наявність нелікованої хронічної артеріальної гіпертензії провокує маніфестацію прееклампсії та поєднаного гестозу у вагітних на 2–3 тижні раніше, ніж у жінок без артеріальної гіпертензії або при її адекватній терапії.Висновки. Наявність некорегованої хронічної артеріальної гіпертензії у вагітних суттєво підвищує частоту розвитку в них пізніх гестозів і значно погіршує прогноз виношування вагітності. Застосування адекватної антигіпертензивної терапії вазодилатуючими бета-адреноблокаторами сприяє достовірному зниженню частоти розвитку прееклампсії та тяжкості її перебігу.

FETAL ECHOCARDIOGRAPHY FOR RISKY PREGNANCIES IN SULAIMANI GOVERNORATE

Background&#x0D; Prenatal diagnosis of congenital heart disease is now well established for a wide range of cardiacanomalies. Diagnosis of congenital heart disease during fetal life not only identifies the cardiac lesion but may alsolead to detection of associated abnormalities. This information allows a detailed discussion of the prognosis with parents. For continuing pregnancies, appropriate preparation can be made to optimize the post natal outcome.Morbidity and mortality, following antenatal diagnosis, has been reported for coarctation of the aorta, hypoplastic left heart syndrome, and transposition of the great arteries.&#x0D; Objective&#x0D; The aim of this prospective study is to evaluate our experience and results of fetal echo for high risk pregnancies in sulaimani city.&#x0D; Methods&#x0D; This is prospective descriptive study conducted on 450 pregnant ladies refered for fetal echocardiography from obstetricians , ultrasonographers and (self referral) from the 1st January 2013 to 1st the February 2017. Echocardiography done with Siemens machine with semicurved phased array probe at their first visit at 16-22 weeks in 330 ladies, at 22-28 weeks in 70 cases and at 31 weeks and above in 50 ladies. Also 2nd visit echo done for 60 patients for follow up at 31-33 weeks gestation. All babies checked post labour for accuracy of the diagnoses.&#x0D; Results&#x0D; Among 450 pregnant ladies, 98 cases found to have abnormal findings , of which 27 diagnosed as hypertrophic cardiomyopathy ( just one persist after 6 months post labour), 25 cases as ASD (just 10 left true ASD postlabour), 14 diagnosed as tricuspid atersia and single ventricle physiology, 5 AVSD , 5 arrhythmia with hydropis , 5 with MV and TV abnormalities, 4 AS, 3 hypoplastic left heart syndrome, 3 PS, 2 l-TGA and one Coa . For cases whom classify as low risk populations of defects no action undertaken, for high risk population decision for termination wan one of the options. 2 miss diagnosis observed after labour checking among anomalies observed echo findings and they were of low risk cases, and no miss diagnosis observed in major risk group diagnosed cases. Fetal echocardiography examination specifity was sensitivity as 97.9% and specifity as 99.4% which is within 95% CI, positive predictive value was 97.9%, negative predictive value was 99.4% in which both within 95% CI.&#x0D; Conclusion&#x0D; The present study showed that fetal echo has great value in detection of congenital heart disease, prognosis and outcome in high risk pregnancies. It’s recommended to familiarize our obstetrician about this important diagnostic test. We should train our ultrasonographer and pediatric cardiologist to increase awareness about this diagnostic test (is it screening test,or a diagnostic test). Also as far as we know this the first paper written on this kind of diagnostic technique , so more studies need to be conducted in the future.

MicroRNA-1291 promotes endometrial fibrosis by regulating the ArhGAP29-RhoA/ROCK1 signaling pathway in a murine model.

Intrauterine adhesions (IUAs) are caused by endometrial damage and are associated with a poor pregnancy prognosis including infertility, oligomenorrhea and recurrent pregnancy loss. Understanding the pathogenesis of IUAs may help prevent and treat this condition more effectively. The aim of the current study was to investigate the function of microRNA-1291 (miR-1291) during the development of IUAs following endometrial damage and elucidate the potential molecular mechanisms involved. The expression of Rho GTPase activating protein 29 (ArhGAP29), a putative target mRNA of miR-1291, was determined by immunohistochemical staining of human endometrial tissue from patients with IUAs and compared with normal endometrial tissues. ArhGAP29 expression was significantly decreased in endometrial tissues with IUAs compared with normal endometrium. Additionally, a murine IUAs model was developed and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) demonstrated that miR-1291 levels were significantly increased in the uterine tissue and plasma of the IUAs group compared with the normal mice. Furthermore, an miR-1291 antagomir was injected into the uterine cavity of experimental IUAs mice to block miR-1291. Hematoxylin and eosin and Masson's stain revealed that blocking miR-1291 significantly ameliorated endometrial fibrosis. Furthermore, levels of epithelial mesenchymal transition (EMT)-associated proteins, and ArhGAP29-RhoA/Rho-associated coiled coil containing protein kinase 1 (ROCK1) were measured in uterine tissue by western blot, RT-qPCR analysis and immunofluorescence staining. Levels of the mesenchymal marker proteins, vimentin and N-cadherin, were increased in the IUAs group mice, accompanied by a relative decrease in the epithelial marker proteins, cytokeratin and E-cadherin compared with normal murine endometrium. miR-1291 inhibition decreased RhoA/ROCK1 expression in the EMT pathway, but increased ArhGAP29 expression. Taken together, the findings indicate that miR-1291 acts upstream of ArhGAP29 to negatively regulate the RhoA/ROCK1 EMT pathway, ultimately leading to endometrial fibrosis. These studies may provide new potential therapeutic options and pave the way to use circulating miR-1291 as a clinical biomarker of endometrial fibrosis.

Pregnancy outcomes among patients with recurrent pregnancy loss and chromosomal aberration (CA) without PGD.

Abstract Background: Recurrent pregnancy loss (RPL) is defined by two or more failed clinical pregnancies. Three to four percent of the couples with RPL have chromosomal aberrations (CA) in at least one partner. The parent’s structural chromosomal abnormalities may cause an unbalanced karyotype in the conceptus which could lead to implantation failure, early or late pregnancy loss, or delivery of a child with severe physical and/or mental disabilities. Objective: To compare live birth rates of couples with CA to couples with normal karyotypes and to investigate medical and obstetric characteristics and pregnancy outcomes of couples with CA and RPL who attend an RPL clinic at a tertiary hospital. Methods: A retrospective cohort study, including 349 patients with two or more consecutive pregnancy losses. The study group consisted of 52 patients with CA, and the control group consisted of 297 couples with normal karyotype. All patients were evaluated and treated in the RPL clinic at Soroka University Medical Center and had at least one subsequent spontaneous pregnancy. Results: The demographic and clinical characteristics were not found to be statistically different between the two groups. The group of carriers of CA had 28/52 (53.8%) live births in their index pregnancy vs. the normal 202/297 (68%) (P=0.067, CI 95%) in the control group. No statistically significant etiology was found between the study group and the control group. A statistically significant difference in live birth rates was found when comparing the total amount of pregnancies [index pregnancy (IP)+post index pregnancy (PIP)] between the study group and the control group (54.16% vs. 67.82%, respectively, P=0.0328). Conclusion: Patients with RPL and CA who have spontaneous pregnancies, have a good prognosis (63.4%) of a successful pregnancy with at least one of the pregnancies (index or post index) resulting in a live birth.

A Profile of Patients with Molar Pregnancy

Aims: This study was done to determine the incidence, modes of presentation and prognosis of molar pregnancy at B. P. Koirala Institute of Health Sciences.Methods: This was a prospective study done among patients with molar pregnancy admitted at BPKIHS from January 2010 to January 2011. The study was conducted after ethical clearance from Institutional Ethical Review Board of BPKIHS. Written informed consent was taken for enrollment in the study. Baseline information like age, address, race and patient’s presenting complaints, period of gestation and serial serum beta human chorionic gonadotropin (βhCG) were collected and analyzed after entering in excel sheet.Results: Total 48 cases of molar pregnancy were diagnosed during the study period. The incidence of molar pregnancy was found to be 5.58 per 1000 deliveries. The most common mode of presentation was per vaginal bleeding i.e. in 64.58% of cases. Majority of the patients were in the age group of 20-34 years (62.5%). Mean time for normalization of βhCG after suction evacuation was 10.19 weeks.Conclusions: Molar pregnancy is a pregnancy related problem which most commonly presents with per vaginal bleeding during first and second trimester. Most of the patients are treated with suction and evacuation but some develop persistent gestational trophoblastic disease.

Perinatal outcomes in multifetal pregnancy following fetal reduction.

There is currently insufficient evidence regarding the prognosis of multifetal pregnancy following elective fetal reduction to twin or singleton pregnancy. We compared perinatal outcomes in pregnancies with and without fetal reduction. We used data on all stillbirths and live births in British Columbia, Canada, from 2009 to 2013. We compared outcomes of multifetal pregnancies with fetal reduction (to twin or singleton pregnancy) with outcomes of pregnancies without fetal reduction. The primary outcome was a composite of serious neonatal morbidity or perinatal death. Other outcomes studied included preterm birth, low birth weight and small-for-gestational-age live birth. The rate of serious neonatal morbidity or perinatal death did not differ significantly between pregnancies reduced to twins and unreduced triplet pregnancies (adjusted rate ratio 0.50, 95% confidence interval [CI] 0.24-1.07) or between pregnancies reduced to singletons and unreduced twin pregnancies (adjusted rate ratio 1.57, 95% CI 0.74-3.33). The rate was significantly lower in the fetal reduction group reduced to twins versus unreduced triplet pregnancies when we restricted the analysis to pregnancies conceived following the use of assisted reproduction technologies (adjusted rate ratio 0.35, 95% CI 0.18-0.67). The rates of preterm birth, very preterm birth, low birth weight and very low birth weight were significantly lower among pregnancies reduced to twins than among unreduced triplet pregnancies. Compared with unreduced twin pregnancies, pregnancies reduced to singletons had lower rates of preterm birth and low birth weight. Fetal reduction to twins and singletons was not associated with a decreased risk of serious neonatal morbidity or perinatal death. However, such fetal reduction was associated with substantial improvements in several other perinatal outcomes, such as preterm birth and low birth weight. Clinicians discussing the risks associated with multifetal pregnancy should counsel parents on the potential risks and benefits of fetal reduction.

Effects of fetal reduction in multi-fetal pregnancy on perinatal outcomes

ABSTRACTBackgroundThere is currently insufficient evidence regarding the prognosis of multi-fetal pregnancies reduced to twins or singletons. We compared the perinatal outcomes of deliveries following fetal reduction with the perinatal outcomes of deliveries without fetal reduction.&#x0D; MethodsWe carried out a retrospective cohort study of all births in British Columbia between 2009 and 2013, using information from a population-based database. Comparisons were made between all women who had a fetal reduction to a twin or a singleton pregnancy with those who did not undergo a fetal reduction procedure. The outcomes of interest were preterm delivery and composite severe neonatal morbidity or perinatal mortality. Generalized estimating equations adjusting for maternal age, parity, pre-pregnancy weight, use of in vitro fertilization and baby’s sex were used to estimate odds ratios (OR) and 95% confidence intervals (CI).&#x0D; ResultsAmong 207,273 deliveries, 139 (0.07%) had a fetal reduction. Of these, 89 women delivered twins and 50 delivered singletons. Women who had a fetal reduction were more likely to have conceived with in vitro fertilization (77.6%) compared with those who did not (3.31%). Twins delivered after fetal reduction had lower rates of neonatal morbidity/mortality (OR 0.19, 95% CI 0.08-0.42) compared with unreduced triplets but rates similar to those of twins without a reduction procedure (OR 1.44, 95% CI 0.81-2.58). Singletons delivered after fetal reduction had non-significantly lower rates of neonatal morbidity/mortality than unreduced twins (OR 0.75, 95% CI 0.36-1.57) but significantly higher rates of neonatal morbidity/mortality (OR 3.98, 95% CI 1.91-8.30), preterm delivery and being small for gestational age than singleton pregnancies without a reduction procedure.&#x0D; ConclusionPerinatal outcomes of twins delivered after fetal reduction are better than those of unreduced triplets and similar to those of unreduced twins.

Non-ART pregnancy predictive factors in infertile patients with peritoneal superficial endometriosis

ObjectiveTo study the predictive factors for non-ART pregnancy in infertile women after laparoscopic diagnosis and surgery for isolated superficial peritoneal endometriosis (SUP). Study designRetrospective observational study from January-2004 to December-2015 in a tertiary care university hospital and Assisted Reproductive Technology (ART) centre. Infertile women with laparoscopic surgery for SUP (with histologic diagnosis) were included. The surgical treatment was followed by spontaneous fertility or post-operative ovarian stimulation (pOS) using superovulation (gonadotrophins)±Intra Uterine Insemination (IUI). The main outcomes were the non-ART clinical pregnancy rates and its predictive factors. Result(s)Over the period study, 315 women were included. Of these, 133 (42.3%) women had non-ART pregnancy. The mean time to conceive was 6 months (±6days). Univariate analysis for non-ART pregnancy after surgery showed that: (i) no difference was observed according to age, length of infertility, Body Mass Index (BMI), the rate of previous pregnancy, and the pre-operative ovarian stimulation rate; (ii) diminished ovarian reserve and previous miscarriage were higher in the non-pregnant women group (8.3 versus 19.1%, p<0.05; 3.5% versus 9%, p=0.06, respectively); (iii) the mean EFI score and pOS were higher in pregnant women (7.7 versus 7.2, p=0.02; 49.2% versus 26.7%, p<0.01); and (iv) IUI did not show any benefit for pregnancy (22% after superovulation versus 27.2% after superovulation and IUI). In the multivariate analysis, only pOS (adjusted OR 2.504, 95% CI [1.537–4.077]) and DOR (aOR 0.420, 95% CI [0.198–0.891]) remained significantly associated with the incidence of pregnancy. Conclusion(s)After laparoscopic surgery for peritoneal superficial endometriosis related infertility, ovarian stimulation improved pregnancy rate, while diminished ovarian reserve had a worse prognosis for pregnancy.

Genetic testing on products of conception for spontaneous miscarriage: euploid status and prognosis for subsequent pregnancy

Genetic testing on products of conception for spontaneous miscarriage: euploid status and prognosis for subsequent pregnancy

EVERREST prospective study: a 6-year prospective study to define the clinical and biological characteristics of pregnancies affected by severe early onset fetal growth restriction

BackgroundFetal growth restriction (FGR) is a serious obstetric condition for which there is currently no treatment. The EVERREST Prospective Study has been designed to characterise the natural history of pregnancies affected by severe early onset FGR and establish a well phenotyped bio-bank. The findings will provide up-to-date information for clinicians and patients and inform the design and conduct of the EVERREST Clinical Trial: a phase I/IIa trial to assess the safety and efficacy of maternal vascular endothelial growth factor (VEGF) gene therapy in severe early onset FGR. Data and samples from the EVERREST Prospective Study will be used to identify ultrasound and/or biochemical markers of prognosis in pregnancies with an estimated fetal weight (EFW) <3rd centile between 20+0 and 26+6 weeks of gestation.MethodsThis is a 6 year European multicentre prospective cohort study, recruiting women with a singleton pregnancy where the EFW is <3rd centile for gestational age and <600 g at 20+0 to 26+6 weeks of gestation. Detailed data are collected on: maternal history; antenatal, peripartum, and postnatal maternal complications; health economic impact; psychological impact; neonatal condition, progress and complications; and infant growth and neurodevelopment to 2 years of corrected age in surviving infants. Standardised longitudinal ultrasound measurements are performed, including: fetal biometry; uterine artery, umbilical artery, middle cerebral artery, and ductus venosus Doppler velocimetry; and uterine artery and umbilical vein volume blood flow. Samples of maternal blood and urine, amniotic fluid (if amniocentesis performed), placenta, umbilical cord blood, and placental bed (if caesarean delivery performed) are collected for bio-banking. An initial analysis of maternal blood samples at enrolment is planned to identify biochemical markers that are predictors for fetal or neonatal death.DiscussionThe findings of the EVERREST Prospective Study will support the development of a novel therapy for severe early onset FGR by describing in detail the natural history of the disease and by identifying women whose pregnancies have the poorest outcomes, in whom a therapy might be most advantageous. The findings will also enable better counselling of couples with affected pregnancies, and provide a valuable resource for future research into the causes of FGR.Trial registrationNCT02097667 registered 31st October 2013.