Single Births Research Articles

IPREFACE score: Integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring.

AimCardiotocography is used worldwide to evaluate fetal well‐being during pregnancy and labor. In past guidelines, the management plan was determined based on the assessment of the most severe waveform. There are no guidelines for evaluating the integrated recurrent decelerations; however, we believe their assessment to be essential for predicting the status of the fetus. The objective of this study was to propose an indicator for performing medical interventions during labor by creating a scoring system that reflects integrated recurrent decelerations.MethodsIn this retrospective cohort study, we included data for only full‐term single fetus births from vaginal deliveries. The score named the iPREFACE score (integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring) was calculated using cardiotocography findings from continuing 30 min before delivery. We examined the iPREFACE score and fetal acidemia association and calculated the cut‐off iPREFACE scores for acidemia using receiver operating characteristic curves.ResultsThe study included 469 delivery cases. Their iPREFACE scores exhibited a significant negative correlation with the umbilical artery blood pH (correlation coefficient; −0.43). The cut‐off iPREFACE scores for the umbilical artery blood with pH <7.20, <7.10 and <7.0 were 44, 46 and 67, respectively (the areas under the curve were 0.776, 0.962 and 0.996, respectively).ConclusionThe iPREFACE score may predict fetal acidemia and could be used as an indicator for timely medical interventions during labor. Because assessments using a cardiotocography are quick and easy to perform, the iPREFACE score could be a valuable tool in clinical practice.

Women\u2019s empowerment and elective cesarean section for a single pregnancy: a population-based and multivariate study in Vietnam

BackgroundWomen’s empowerment, and maternal and neonatal health are important targets of the Sustainable Development Goals. Our objective is to examine the relationship between women’s empowerment and elective cesarean section (ECS), focusing on Vietnam, a country where the use of CS has increased rapidly in recent decades, which raises public health concerns.MethodsWe hypothesized that in the context of the developing biomedicalization of childbirth, women’s empowerment increases the use of ECS due to a woman’s enhanced ability to decide her mode of delivery. By using microdata from the 2013–2014 Multiple Indicator Clusters Survey, we conducted a multivariate analysis of the correlates of ECS. We studied a representative sample of 1343 institutional single birth deliveries. Due to higher ECS rates among multiparous (18.4%) than primiparous women (10.1%) and the potential interaction between parity and other correlates, we used separate models for primiparous and multiparous women.ResultsAmong the indicators of women’s external resources, which include a higher level of education, having worked during the previous 12 months, and having one’s own mobile phone, only education differed between primiparous and multiparous women, with a higher level among primiparous women. Among primiparous women, no resource indicator was significantly linked to ECS. However, considering women’s empowerment facilitated the identification of the negative impact of having had fewer than 3 antenatal care visits on the use of ECS.Among multiparous women, disapproval of intimate partner violence (IPV) was associated with a doubled likelihood of undergoing ECS (odds ratio = 2.415), and living in an urban area also doubled the likelihood of ECS. The positive association with living in the richest household quintile was no longer significant when attitude towards IPV was included in the model. In both groups, being aged 35 or older increased the likelihood of undergoing ECS, and this impact was stronger in primiparous women.ConclusionsThese results underline the multidimensionality of empowerment, its links to other correlates and its contribution to clarifying the influence of these correlates, particularly for distinguishing between medical and sociocultural determinants. The results advocate for the integration of women's empowerment into policies aimed at reducing ECS rates.

CAUSES OF VARIATION IN REPRODUCTIVE PERFORMANCE OF WEST AFRICAN DWARF GOAT

Analysis was carried out on the reproductive performance of 59 WAD (Foula djullon) goats over 8 year period 1982-1990) under intensive management. The data involving a total of 176 kiddings comprising 311 kids were analysed to provide some information on the reproductive potential and the distribution of the Sexes on the WAD goats for an appraisal of its utilization for future genetic and environmental studies and the improvement of the breed in Nigeria. The results showed no significant seasonal effect on the kidding pattern. Singles, twins and triplets were 33.44, 48,23 and 16,40% respectively. Kidding interval varied from 91 to 2.10 days, annual kidding rate was 1..68 with mean kid birth weight of 1.5 +0.138, 1.49 +0.65 and 1.31+0.095kg for single twins and multiple births respectively. The average sex ratio was 48.79+0.18. The least squares constants showed that the age of dam, kidding interval and Season of kidding have significant effect on the sex ratio with more males born by those after 3 years of age particularly during the dry season 't shorter kidding intervals or 191-220 days. Calculated frequency of sex combination of males to females was 0.4005, 0.4662 and 0.1333 trizygotic, dizygotic and monozygotic twins among the triplets - The frequency was 0.67 for monzygotic twinning among the twin births. Although preweaning mortalities of 12.26, 16.33 and 19.36% were recorded for single, twin and multiple births respectively, highly significant survival rate was recorded in the dry season (84.40+0.75) than in the wet season 81,18 +0.75 whilst the kidding interval was between 200 - 240 days in about 56% of the population studied. The current emphasis on the presence of monozygotic twins with a frequency of 67% among twin birth and 13.3% among the triplets is to assist in utilizing this trait in the goat for studies that could enhance the modification of the environment or improve the genetic potentials of the breed.

A Cohort Study on Survival Predictors of Low Birth Weight Newborns

Introduction: Low Birth Weight (LBW) represent a vulnerable group of newborns associated with high risk of complications thus have a high mortality rate. There are many factors affecting the early survival of LBW neonates. There are limited studies providing the evidence on survival predictors in the newborns in western Indian region. Aim: To identify the various factors determining the survival of LBW newborns. Materials and Methods: This was a prospective cohort study conducted in the Neonatal Intensive Care Unit (NICU) of the Department of Paediatrics, Jay Kay Lon Mother and Child Hospital, a neonatal and paediatric tertiary care centre attached to Government Medical College, Kota, India over a period from January 2011 to December 2011. Three hundred and sixty two newborns, admitted to the neonatal intensive care unit with birth weight &lt;2500 gm within 24 hours of birth, were included in the study. Data were interpreted by using Statistical Package for Social Sciences (SPSS) Software for windows version 20.0. Those babies that were transferred and directly discharged to home were pooled as survivors and for the purpose of analysis were compared to babies that died during hospital stay. Associations between categorical variables and survival and death outcome were performed using the Chi-Square test. The p-value less than or equal to 0.05 was considered significant. Results: This study of total sample of 362 newborns, reported a survival rate of 76.52% (277) and a mortality of 23.48% (85). Single gestation birth had better survival (78.69%) than multiple births (64.91%) (p=0.024). The survival improved as the birth weight increased (p&lt;0.001). The survival in female was better (82.31%) as compared to males (72.56%) (p=0.032). The survival in Appropriate for Gestational Age (AGA) newborns was better (79.85%) than Small for Gestational Age (SGA) (67.68%) (p=0.0149). Neonates delivered to mothers who received antenatal steroids had a survival rate of 76.14% as compared to 68.13% in those who had not received steroids (p&lt;0.02). Main cause of mortality in the study group was Respiratory Distress Syndrome (RDS) (86.36%) followed by Birth Asphyxia (BA) (33.33%) and Necrotising Enterocolitis (NEC) (33.33%). Conclusion: The BA and RDS were the most common cause of neonatal mortality among various other complications related to prematurity and LBW. However, there are several factors that interplay and it is not possible to single out any particular factor influencing LBW survival. Reducing perinatal mortality requires a multidimensional approach with timely identification and appropriate management of the issues related to potential complications of prematurity as RDS, LBW and BA.

Inverse problems for ergodicity of Markov chains

For continuous-time Markov chains, we provide criteria for non-ergodicity, non-algebraic ergodicity, non-exponential ergodicity and non-strong ergodicity. For discrete-time Markov chains, criteria for non-ergodicity, non-algebraic ergodicity and non-strong ergodicity are given. Our criteria are in terms of the existence of solutions to inequalities involving the Q-matrix (or transition matrix P in the time-discrete case) of the chain. These practical criteria are applied to some examples, including a special class of single birth processes and several multidimensional models.

Kıl Keçilerinde Üreme Mevsiminde Kızgınlık Senkronizasyonu Uygulamasının Döl Verimi ve Doğum Ağırlığı Üzerine Etkisi

Bu çalışma ile Kıl keçilerinde üreme mevsimi içinde kızgınlık senkronizasyon uygulamasının döl verimi üzerine etkisinin belirlenmesi amaçlanmıştır. Hayvan materyali olarak 3-5 yaş aralığında toplam 200 baş kıl keçisi kullanılmıştır. Keçiler eşit sayıda olacak şekilde iki gruba ayrılmışlardır (Kontrol grubu, KG n=100; Kızgınlık senkronizasyon grubu, KS, n=100). KS grubuna, 30 mg flugeston asetat içeren sünger takılmış ve 12 gün sonra çıkarılarak hayvan başına 500 IU PMSG kas içi uygulanmıştır. 4 gün süreyle kıl tekeleri kullanılarak çiftleştirme işlemi gerçekleştirilmiştir. Teke katım işlemi her iki grupta da aynı anda başlatılıp 4 gün sonra sonlandırılmıştır. Tekiz doğum oranı KG‘da %72, KS grubunda ise %35 olarak gerçekleşmiştir. Teke altı keçi başına doğan oğlak sayısı ve doğuran keçi başına doğan oğlak sayısı sırasıyla KG‘da 1,20 ve 1,59, KS grubunda ise 1,25 ve 1,64 olarak tespit edilmiştir. Sonuç olarak, Kıl keçilerinde üreme mevsimi içinde kızgınlık senkronizasyon uygulaması döl verimini iyileştirmiştir.

On the rate of convergence for a class of Markovian queues with group services

There are many queuing systems that accept single arrivals, accumulate them and service only as a group. Examples of such systems exist in various areas of human life, from traffic of transport to processing requests on a computer network. Therefore, our study is actual. In this paper some class of finite Markovian queueing models with single arrivals and group services are studied. We considered the forward Kolmogorov system for corresponding class of Markov chains. The method of obtaining bounds of convergence on the rate via the notion of the logarithmic norm of a linear operator function is not applicable here. This approach gives sharp bounds for the situation of essentially non-negative matrix of the corresponding system, but in our case it does not hold. Here we use the method of differential inequalities to obtaining bounds on the rate of convergence to the limiting characteristics for the class of finite Markovian queueing models. We obtain bounds on the rate of convergence and compute the limiting characteristics for a specific non-stationary model too. Note the results can be successfully applied for modeling complex biological systems with possible single births and deaths of a group of particles.

Comparison of the single nucleotide polymorphisms and expression of FSHβ and LHβ genes between prolific and non-prolific goat breeds of Kerala

Attappady Black and Malabari breeds of goats are native to Kerala, a southern state of India. Attappady Black is a low prolific breed whereas Malabari breed is highly prolific. Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) are the gonadotropins which are considered to be the central hormones controlling prolificacy. The present study aimed to detect presence of SNPs in exonic regions of FSHβ and LHβ and the expression of these gonadotropins in both these breeds. Blood samples were collected from ten does five each from Attappady Black and Malabari goats and the genomic DNA was extracted. Multiple primers were designed based on Ensembl Genome Browser sequences to cover the entire exonic regions of both the genes for SNP detection. Pooled PCR products of FSHβ and LHβ separately from the two breeds were sequenced. Nucleotide sequencing showed synonymous single nucleotide polymorphism T → C, in FSHβ coding sequence, at position 413 (as per FSHβ ENSCHIG00000022859), in both Attappady Black and Malabari goats. Numerous other SNPs both novel and reported were detected in the non-coding regions of FSHβ. In LHβ of Attappady Black goat, an SNP was found at exonic position 455 (G → A) as per LHβ ENSCHIT00000012663.1. This transition resulted in replacement of amino acid arginine (R) with glutamine (Q). Upon individual sequencing of ten each of single birth and multiple birth Attappady Black goat samples, three animals with single birth and five animals with multiple birth showed G → A change in the LHβ transcript at position 455. Pituitary samples were collected from 6 animals each from both the breeds and expressions of both the genes were quantified using qRT-PCR technique. There was no significant difference in pituitary FSHβ expression between breeds. However, there was a significant difference (P < 0.01) in LHβ expression between the two breeds with an increase in expression of 2.61 folds in Attappady Black breed. This study forewarn a main role for LH in the genetic network controlling prolificacy in these goat breeds and this necessitates further investigation with larger sample size and also in other goat breeds.

Experienced support from family, school and friends among students in out‐of‐home care in a school‐based community survey

AbstractYouth in out‐of‐home care have elevated risks for adverse events and detrimental circumstances possibly affecting their development. Responses from 311 students in out‐of‐home care (OHC) were compared with peers living in birth parent care (BPC) and in single birth parent care (sBPC) in a regional school survey, directed to students in compulsory school eighth year and upper secondary school second year. Results indicate OHC students to experience less satisfaction with friends, leisure time, and families. They state less trust in support from friends and families but a more similar level to teachers, counsellors or nurses. OHC students also express being more exposed to abusive experiences online and perceive less sense of security at home and in school. We conclude that welfare institutions need to recognize the components in building trust and safety for students in OHC and that school and other professional institutions have an important role in serve resilience and promote well‐being for children in OHC.

Fertility Behaviour of Adolescent Mothers in Northern Nigeria and Neonatal Mortality Risk: Mediating Effect of Quality Maternal Health Services

Background: Despite rising prevalence of high-risk birth and adverse birth outcome among adolescent mothers in Nigeria, there is paucity of studies relating childhood mortality risk with fertility behaviour of adolescent mothers. This study examines fertility behaviour of adolescent mothers in northern Nigeria and neonatal mortality risk.&#x0D; Methods: Data were derived by pooling together the three most recent Nigeria Demographic and Health Surveys (NDHS, 2008, 2013 and 2018). The sample size comprises of weighted sample of 3,739 adolescent mothers 15-19 years with 5, 274 live births for the period under consideration. Survival analysis (cox proportional hazard model) was used to estimate the hazard of neonatal mortality risk as a result of risky fertility behaviour.&#x0D; Results: Quality of maternal health service utilization was poor among (73.0%) of the adolescent mothers. The independent effect of adolescent fertility behaviour revealed a rise in hazard for neonatal mortality, with increasing high risk fertility behaviour, single high-risk (HR=2.69, p&lt;0.001) and multiple high risk (HR=6.04, p&lt;0.001). Adjusting for quality of maternal health service utilization, resulted in reduced hazard for neonatal mortality, though the result did not reach statistical significance (p&gt;0.05). Adjusting for maternal, child characteristics and quality of maternal health service utilization, resulted in reduced hazard for neonatal mortality, though, the effect of risky fertility behaviour remained insignificant. Multiple birth babies were however, associated with elevated hazard for neonatal mortality (HR=11.4, p&lt;0.05) relative to single birth babies.&#x0D; Conclusion: Adolescent fertility behaviour was associated with elevated hazard for neonatal mortality.

The Impact of Preconception TSH on the Reproductive Outcomes of Infertile Women Undergoing the First Fresh D3 Embryo Transfer Cycle.

Purpose To investigate the association between high-normal preconception TSH levels and reproductive outcomes in infertile women undergoing the first fresh D3 embryo transfer. Methods This was a retrospective study. Euthyroid patients undergoing the first fresh D3 embryo transfer from January 2018 to May 2019 were initially included. The patients were divided into a low-TSH (0.27–2.5 mIU/L) group and a high-normal TSH (2.5–4.2 Miu) group. The reproductive outcomes were compared between the groups. Results A total of 1786 women were ultimately included, in which 1008 of whom had serum TSH levels between 0.27 and 2.5 mIU/L and 778 of whom had serum TSH levels between 2.5 and 4.2 mIU/L. The patients were highly homogeneous in terms of general characteristics. High-normal TSH levels had no adverse impact on the clinical pregnancy rate, miscarriage rate, or live birth rate (respectively, aOR = 0.92, 1.30, and 0.88 and P = 0.416, 0.163, and 0.219). No significant differences were observed in terms of gestational age, single live birth rates, and birth weight, or birth length. Conclusion High-normal TSH levels did not significantly influence reproductive outcomes in infertile women undergoing the first fresh D3 embryo transfer. Further studies are needed to test whether the results might be applicable to a wider population.

Rural-urban differentials in the determinants of under-five mortality in Bhutan

PurposeThe differences in the distribution of factors associated with under-five mortality (UFM) can help explain the rural-urban inequities in UFM. The determinants contributing to UFM in rural and urban areas have not been previously explored in Bhutan. This study examined the factors associated with UFM in rural and urban Bhutan and the role of the factors in explaining UFM disparity.Design/methodology/approachThe dataset of 6,398 single births (4,999 in rural and 1,399 in urban areas) from the 2012 Bhutan National Health Survey was analyzed. Logistic regression analysis accounting for the complex survey design was performed to investigate the determinants.FindingsThe UFM rate was 2.75 times higher in rural than in urban Bhutan. In rural communities, children of younger mothers, born in households without safe sanitation and electricity, and central and eastern regions had increased UFM odds. Whereas, children born to working mothers and educated fathers, and born in households with non-working household heads had lower UFM odds in urban areas. A higher number of births and smaller household size was associated with an increased UFM odds irrespective of rural-urban residence. Environmental factors were attributable for the largest portion of rural UFM disadvantage.Originality/valueThis study helps to understand the rural-urban differences in the factors influencing UFM in Bhutan. The findings suggest that policies aimed to improve environmental and socioeconomic conditions, women empowerment, and those aimed to enhance health utilization can help reduce the rural-urban child survival disparity and accelerate the achievement of the Sustainable Development Goal target.

Crecimiento de corderos y productividad en ovejas Pelibuey mantenidas bajo condiciones tropicales de producción

El objetivo fue evaluar los efectos de época y año de nacimiento, tipo de parto, sexo y número de parto sobre el crecimiento predestete y la productividad de las ovejas en ovinos de raza Pelibuey que producen bajo un sistema semi-extensivo en el trópico húmedo de México. Se usaron datos de 323 ovejas Pelibuey a partir de registros de producción de 2011-2017. Se evaluaron los pesos al nacimiento (PN) y al destete (PD, a 60 d), así como los pesos de camada al destete (PCD). Adicionalmente, se evaluó prolificidad, mortalidad hasta el destete y kilos de cordero producido por oveja en un ciclo de 240 días (PC240d). Todos los factores afectaron (P≤0.05) las variables de respuesta. Los corderos procedentes de partos múltiples tuvieron menor (P&lt;0.05) PN y PD, pero mayor (P&lt;0.05) PCD, PC240d y mortalidad que los corderos procedentes de partos simples. Los corderos nacidos en época de seca tuvieron mayores (P&lt;0.05) PN y PD, mientras que las ovejas tuvieron mayores PCD y PC240d, comparado con otras épocas del año. Las ovejas primíparas tuvieron corderos más livianos (P&lt;0.05) al nacimiento y al destete, así como menor (P&lt;0.05) prolificidad, PCD y PC240d que las ovejas multíparas (≥3 partos). El año de nacimiento afectó (P&lt;0.05) PN, PD, tasa de mortalidad y características de productividad. En conclusión, se observó un mejor desempeño en el crecimiento predestete para corderos Pelibuey nacidos de ovejas multíparas y con parto simple en la época de seca. Sin embargo, la productividad de la oveja fue mejor con la presencia de partos dobles, en tiempo de sequía, y con el aumento en número de partos.

Medical report on the activities of the Obstetric Department of the Gynecological Clinic prof. N.V. Yastrebova at the Imperial Warsaw University in 1890 (from 15 / III), 1891 and 1892 (until 15 / III)

Of the total number of births during the reporting period (931), in 910 cases, births were single and in 21 multiple births twins (or 2.26%). The ratio of multiple births to single births = 1: 43.3, which is higher than in the previous reporting years 1: 66. Twins are accounted for in 43.3 single births.

Epidemiology, prenatal diagnosis, and neonatal outcomes of congenital heart defects in eastern China: a hospital-based multicenter study

BackgroundCongenital heart defect is the leading malformation in China. There may have been changes in congenital heart defect incidence because of birth policy shift in China over past years. This study aimed to investigate the epidemiology, prenatal diagnosis, and outcomes of congenital heart disease to improve medical and policy decisions.MethodsData on cases of congenital heart disease identified during 2014–2018 were taken from the Zhejiang provincial birth defects surveillance system. Chi-square test, odds ratio (OR) and 95% confidence interval (CI) were used to explore epidemiology, prenatal diagnosis, and birth outcomes of congenital heart disease.ResultsThe average incidence of congenital heart disease was 16.0 per 1000 births, which increased by 62.2% during 2014–2018(χ2trend = 181.41, P < 0.001). However, the average critical congenital heart incidence was 1.6 per 1000 births, which remained stable over time. Women aged ≤20 years (OR2.1, 95% CI 1.9–2.3) or ≥ 35 years (OR 1.2, 95% CI 1.2–1.3) were at higher risk of having babies with congenital heart disease than women aged 21–34 years. Women who gave birth in urban areas (OR 1.2, 95% CI 1.2–1.3), had a son (OR 1.3, 95% CI 1.3–1.4), or had multiple births (OR 4.0, 95% CI 3.7–4.4) were also at higher risk than those giving birth in rural areas, to girls, or single births, respectively. The three major subtypes of congenital heart disease were atrial septal defect (67.9%), patent ductus arteriosus (34.7%), and ventricular septal defect (6.4%). The prenatal detection rate of critical congenital heart disease was 90.0%, which was far higher than total congenital heart disease, at 22.2% (χ2 = 1687.67, P < 0.001). There were 1457 (17.1%) stillbirths, 106 (1.2%) early neonatal deaths, and 6983 (81.7%) live births associated with congenital heart disease.ConclusionsThe high incidence of congenital heart disease in Zhejiang might be attributable to the large proportion of mild congenital heart disease. The incidence of critical congenital heart disease, the prenatal detection rate, and perinatal deaths from congenital heart disease are comparable to those in other studies.

INCIDENCE OF MULTIPLE BIRTHS IN RELATION TO CURRENT REGULATIONS IN TURKEY REGARDING EMBRYO TRANSFER

The aim of our study is to evaluate the 2010 regulations in Turkey regarding the number of embryos which can be transferred. This retrospective single center study evaluated single versus multiple births before and after the introduction of 2010 Turkish regulations. The study is based on data from Istanbul Memorial Hospital, ART and Genetics Center used to evaluate the 2010 regulations, which restricts the number of embryos to be transferred. According to the regulation; double embryo transfer (DET) is allowable after two unsuccessful attempts in cases up to maternal age of 35 and in any one cycle in cases ≥35. For the period from March 2003 to June 2019, a total of 31,459 cycles were analyzed to evaluate the overall effect of 2010 regulations. For the period from January 2014 to July 2019, a total of 4450 cycles were evaluated according to two different ages groups, patients <35 and patients from 35-42 years of age with single or double blastocyst transfer performed in compliance with current regulations. First the overall effect of the introduction of the regulations on multiple births was evaluated regardless of previous ART attempts and maternal age. Secondly, the clinical results of fresh and frozen-thawed single or double blastocyst transfer in patients <35 years with a history of 2 or 3 previous unsuccessful ART attempts and in patients ≥ 35 (35-42) years with a history of either no previous attempts or 1,2 or 3 attempts were evaluated. In the first study groups (March 2003 to July 2019), the parameter most significantly affected by the introduction of the regulations was the number of the embryos transferred. The percentage of single embryo transfer (SET ) cycle increased dramatically from 14% to 56.6%. However, despite a fall from 32.4%, the incidence of twin births remained high at 15.5%. In the second study groups from January 2014 to July 2019, in young patients <35 years with 2 or 3 previous cycles, the twin birth rate was very high at 47.26 % in the double blastocyst group whereas it was only 1.75% when a single blastocyst was transferred (p=0.0001). In patients ≥ 35 years (35-42) with zero,1,2 and 3 previous cycles, in the double blastocyst transfer group, the twin birth rate was again high at 28.4% whereas in the single blastocyst transfer group it was only 1.8% (p=0.0001). Importantly, there was no statistically significant difference in clinical pregnancy rates between these two groups (67.4% vs 67.5% in the <35 group, and 59.1% vs 54.1% in the ≥ 35 year group) (p=0.846 and p=0.055). Thus, in DET, there was a high risk of twin births and no advantage in terms of pregnancy rates. As a result of the wording of the current regulations, there has been a high demand for DET in both young and older patients. Our study strongly suggests that, especially in the light of the success of blastocyst transfer, the Turkish regulations should be amended to limit the use of DET and encourage the use of SET apart from in exceptional cases and particularly in women under 35 years old.

IS EARLY HCG PREDICTIVE OF PREGNANCY AFTER ESET IN BOTH FRESH AND FET CYCLES?

Most ART programs perform β-hCG measurement 9-12 days after embryo transfer(ET) to detect a pregnancy. A prior study using hyperglycosylated hCG in a small sample size showed that a single measurement 6 days after ET had 100% sensitivity and specificity in identifying biochemical and ongoing pregnancies. We sought to determine whether routine serum β-hCG measurement at 5-6 days after ET is predictive of ART outcome. This is important in patient counseling if we can stop P supplementation early in cases of negative tests, especially if taking painful IM P supplementation. Prospective single center. A total of 241 patients undergoing eSET (elective single embryo transfer) had their “early” serum β-hCG measured 5-6 days after ET, and the “official” serum β-hCG was done 9-10 days after ET. There were 91 fresh ET and 150 FET cycles. A test was positive if the β-hCG measurement was ≥ 3 IU/L. All tests were performed at a commercial laboratory with offices around the US (LabCorp). In the 91 fresh ET cases observed, 65 had positive and 26 had negative “early”β-hCG tests measured 5-6 days post ET. Of the 65 positive β-hCG tests, 10 (15.4%) were biochemical, 9 (13.8%) were pregnancy losses (SAB), and 46 (70.8%) were live births. Of the 26 negative tests, 24 (92.3%) were negative on days 9-10 and 2 (7.6%) were positive on days 9-10. Both positive results on day 9-10 ended with biochemical losses. In the 150 FETs observed, 81 had positive and 69 had negative “early” β-hCG. Of the 81 positive, 19 (23.5%) were biochemical pregnancies, 7 (8.6%) had SAB, and 55 (67.9%) were ongoing/live births. Of the 69 negative β-hCG tests measured 5-6 days post FET, 4 (5.7%) were then positive on day 9-10, 3 resulting in biochemical pregnancies and one live birth. The mean “early” β-hCG levels in the IVF group was 27.03 IU/L which was significantly higher than in the FET 14.09 IU/L (P<0.001). There were significant differences in early β-hCG results between ongoing/delivered and biochemical pregnancies in both fresh and FET groups (P<0.001), but not between ongoing/LB and SAB. However, by first β-hCG level on days 9-10 there were no differences in the mean β-hCG between the 2 groups (P=0.04). ROC for fresh ET showed a cut off value of 7 IU/L. The test can detect with 90% sensitivity a 96% specificity with 3.8% false positive (AUC=0.972). For FET it showed a cut off value of 3.7 IU/L. The test can detect with 89% sensitivity a specificity of 94% with 5.7% false positive (AUC=0.964) (Figure 1). Early serum β-hCG measured 5-6 days after ET in eSET cycles is very predictive of successful pregnancies. A negative test 5-6 days after ET is associated with a negative 9-10 day β-hCG test in both fresh and FET cycles. In the fresh group, an early negative β-hCG was 100% predictive of no live births, but in the FET group an early negative in the FET group led to a single live birth (99.33% predictive of no live births). FET cycles were associated with lower early β-hCG levels than fresh transfers but became similar to fresh cycles on the first day of actual pregnancy test. This information is of potential benefit in counseling women undergoing ART.

Decreasing cerebral palsy prevalence in multiple births in the modern era: a population cohort study of European data

Multiple births (twins or higher order multiples) are increasing in developed countries and may present higher risk for cerebral palsy (CP). However, few studies can reliably investigate trends over time...

High-Normal Preconception TSH Levels Have No Adverse Effects on Reproductive Outcomes in Infertile Women Undergoing the First Single Fresh D5 Blastocyst Transfer.

Purpose To investigate the association between high-normal preconception TSH levels and reproductive outcomes in infertile women undergoing the first single fresh D5 blastocyst transfer. Methods This was a retrospective study. Euthyroid patients undergoing the first single fresh D5 blastocyst transfer from January 2018 to May 2019 were initially included. The patients were divided into a low TSH (0.27–2.5 mIU/L) group and a high-normal TSH (2.5–4.2 mIU/L) group. The reproductive outcomes were compared between the groups. Results A total of 824 women were ultimately included, 460 of whom had serum TSH levels less than 2.5 mIU/L and 364 of whom had serum TSH levels between 2.5 and 4.2 mIU/L. The patients were highly homogeneous in terms of general characteristics. High-normal TSH levels had no adverse impact on the clinical pregnancy rate, miscarriage rate, or live birth rate (respectively, aOR = 0.84, 0.65, 0.61, and P=0.234, 0.145, 0.083). No significant differences were observed in terms of gestational age, single live birth rates, birth weight, or birth length. Conclusion High-normal TSH levels did not significantly influence reproductive outcomes in infertile women undergoing the first single fresh D5 blastocyst transfer. Further studies are needed to test whether the results might be applicable to a wider population.

Sociodemographic factors and prenatal care behaviors associated with unplanned pregnancy in a Brazilian birth cohort study.

To identify the sociodemographic factors and prenatal behavior characteristics associated with unplanned pregnancy. A cross-sectional survey was conducted of mothers of newborns enrolled in a birth cohort in Ribeirão Preto, Brazil. Questionnaires were administered to postpartum women. Multiple logistic regression was used to identify sociodemographic predictors of unplanned pregnancy and to evaluate the association with adherence to prenatal care recommendations. The cohort included 7608 mothers: 7541 (99.1%) answered the interview and 4056 (53.8%) had an unplanned pregnancy. Adolescents were more likely to have an unplanned pregnancy (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.50-2.34) as were women over 40 (OR 1.74; 95% CI 1.22-2.47). Pregnancy during adolescence (OR 1.27; 95% CI 1.09-1.48), being single (OR 7.56; 95% CI 5.98-9.56), having two or more previous births (OR 1.73; 95% CI 1.52-1.97), and being of a lower socioeconomic status were also predictors. Lack or late initiation of prenatal care, attendance at less than six prenatal visits, drinking alcohol, and smoking during pregnancy were associated with unplanned pregnancy. Unplanned pregnancies disproportionately affect women at extremes of age, single, and of low socioeconomic status. These women are less likely to adhere to prenatal care.