Iatrogenic multiple birth, multiple pregnancy and assisted reproductive technologies

1999 ◽  
Vol 64 (1) ◽  
pp. 11-25 ◽  
Author(s):  
L Keith ◽  
J.J Oleszczuk
Keyword(s):  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
Multiple Birth

scholarly journals Possibility of reducing blood loss during and after multiple birth

2016 ◽  
Vol 97 (6) ◽  
pp. 934-938
Author(s):  
N R Akhmadeev ◽  
F I Fatkullin ◽  
G R Khayrullina ◽  
N Yu Bystritskaya
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
Active Management ◽  
Multiple Birth

Multiple pregnancy and multiple birth are pathologic obstetric situations. Recently occurrence of multiple pregnancy has increased due to increase of the age at planned pregnancy and widespread use of assisted reproductive technologies including in vitro fertilization. As a result clinicians practicing in obstetrics face more frequent multiple pregnancies, mostly twins. Risk of bleeding during multiple pregnancy, delivery and the postpartum period is estimated as high and is two times higher than in single pregnancy. The main causes of postpartum hemorrhage in multiple pregnancy are uterine hypotony or atony. Hemostatic changes occurring during pregnancy, unspecific and specific complications of multiple pregnancy are important as well. Correct management of the second period of a multiple vaginal delivery allows reducing the volume of blood loss. Method of fetal extraction in the intact amniotic sac allows reducing the influence of external factors on neonate’s head and the volume of blood loss during Cesarean section. Blood loss reducing is caused by amniotic sac compressing the vessels and therefore decreasing bleeding from the uterine incision for the time enough to extract the fetuses. Active management of the third period of vaginal delivery and afterbirth extraction with traction of umbilical cord during Cesarean section are crucial. Suggested regimens of uterotonics (oxytocin, carbetocin, misoprostol) and antifibrinolytics (tranexamic acid) reduce the risk of postpartum hemorrhage.

Clinical and statistical analysis of obstetrics and perinatal complications in singleton and multiple pregnancy after assisted reproductive technology

2018 ◽  
pp. 67-73
Author(s):  
T.G. Romanenko ◽  
◽  
O.M. Sulimenko ◽  
S.O. Ovcharenko ◽  
◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Fetal Growth ◽  
Growth Retardation ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Fetal Distress ◽  
Reproductive Technologies ◽  
Fetal Growth Retardation ◽  
Multiple Pregnancies ◽  
Perinatal Complications

The objective: conduct a comparative clinical and statistical analysis of obstetric and perinatal complications in singleton and multiple pregnancies after assisted reproductive technologies (ART) according to archival documents (pregnancy observation data and birth history) and identify features of multiple pregnancy. Materials and methods. During the period 2017–2019, 522 women gave birth in maternity hospital «Leleka» after assisted reproductive technologies, 331 women were observed in the maternity hospital «Leleka». 445 women gave birth with a singleton pregnancy and 77 with a multiple pregnancy. A clinical and statistical analysis of 150 pregnancy and childbirth histories was performed. All pregnant women were divided into two groups: Group I – 75 pregnant women with singleton pregnancies after ART; Group II – 75 pregnant women with multiple pregnancies after ART. The selection criteria for comparative clinical and statistical analysis were women whose pregnancies occurred as a result of ART, namely by in vitro fertilization (IVF) using five-day frozen embryos. Mathematical research methods were performed in accordance with the recommendations of O.P. Minzer (2013). The reliability of the cancellation of the mean pairs was calculated using the Student’s and Fisher’s criteria. Graphs were designed using the program «Microsoft Excel». Results. Complications of early pregnancy in multiple pregnancies were: anemia (47.8% vs. 22.9%; p<0.01), placental dysfunction (43.3% vs. 22.9%; p<0.01), the threat of abortion (41.8% vs. 28.6%; p<0.01). Complications of the second half of pregnancy: preeclampsia (52.7% vs. 20.6%; p<0.01), fetal growth retardation (20.0% vs. 7.4%; p<0.01), gestational anemia (76,4% vs. 32.4%; p<0.01), placental dysfunction (47.3% vs. 22.1%; p<0.05). Complications in childbirth in women with multiple pregnancies were as follows: premature rupture of membranes (30.9% vs. 10.3%; p<0.05), anomalies of labor activity (16.4% vs. 5.9%; p>0.05), fetal distress (29.1% vs. 14.7%; p<0.05), premature placental abruption (3.6% vs. the absence of this indicator in group I). In patients of group II with multiple pregnancies 3.7 times more often the pregnancy ended prematurely compared with singleton (21.8% vs. 5.9%; p<0.05). Early preterm births predominated, of which births occurred in 3.6% of cases at 22–28 weeks, 7.3% at 28–32 weeks, and 6.4% at 32–34 weeks. Significant increase in the frequency of 32.7% of abdominal births in multiple pregnancies against 11.8% of patients in pregnancy with a single fetus (p<0.01). The structure of indications in patients of group II was as follows: severe preeclampsia 27.8%, development of fetal growth retardation and fetal distress of 11.1%, respectively, premature placental abruption 16.7%, the following single indications (pelvic presentation of the fetus, transverse or oblique position of the fetus, clinically narrow pelvis, abnormalities of labor, scar on the uterus) – 33.3%. Significant increase in the total frequency of neonatal asphyxia of varying severity in multiple pregnancies (35.0% vs. 5.9%; p<0.05), fetal growth retardation (27.3% vs. 11.8%; p<0.01). Conclusions. Multiple pregnancies are a high risk factor for gestational anemia, preeclampsia, placental dysfunction, early fetal growth retardation, and fetal distress during pregnancy and childbirth. This causes a high level of abdominal delivery. Therefore, further research to predict and prevent obstetric and perinatal complications in multiple pregnancies after ART is relevant today. Keywords: obstetric and perinatal complications of pregnancy, multiple pregnancy, assisted reproductive technologies.

scholarly journals Aromatase Inhibitors for Ovulation Induction

2006 ◽  
Vol 91 (3) ◽  
pp. 760-771 ◽  
Author(s):  
Robert F. Casper ◽  
Mohamed F. M. Mitwally
Keyword(s):  
Side Effects ◽  
Aromatase Inhibitors ◽  
Ovulation Induction ◽  
Assisted Reproductive Technologies ◽  
Evidence Synthesis ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Significant Risk ◽  
Reproductive Technologies ◽  
Poor Responders

Abstract Context: For the last 40 yr, the first line of treatment for anovulation in infertile women has been clomiphene citrate (CC). CC is a safe, effective oral agent but is known to have relatively common antiestrogenic endometrial and cervical mucous side effects that could prevent pregnancy in the face of successful ovulation. In addition, there is a significant risk of multiple pregnancy with CC, compared with natural cycles. Because of these problems, we proposed the concept of aromatase inhibition as a new method of ovulation induction that could avoid many of the adverse effects of CC. The objective of this review was to describe the different physiological mechanisms of action for CC and aromatase inhibitors (AIs) and compare studies of efficacy for both agents for ovulation induction. Evidence Acquisition: We conducted a systematic review of all the published studies, both controlled and noncontrolled, comparing CC and AI treatment, either alone or in combination with gonadotropins, for ovulation induction or augmentation, identified through the Entrez-PubMed search engine. Evidence Synthesis: Because of the recent acceptance of the concept of using AIs for ovulation induction, few controlled studies were identified, and the rest of the studies were pilot or preliminary comparisons. Based on these studies, it appears that AIs are as effective as CC in inducing ovulation, are devoid of any antiestrogenic side effects, result in lower serum estrogen concentrations, and are associated with good pregnancy rates with a lower incidence of multiple pregnancy than CC. When combined with gonadotropins for assisted reproductive technologies, AIs reduce the dose of FSH required for optimal follicle recruitment and improve the response to FSH in poor responders. Conclusions: Preliminary evidence suggests that AIs may replace CC in the future because of similar efficacy with a reduced side effect profile. Although worldwide experience with AIs for ovulation induction is increasing, at present, definitive studies in the form of randomized controlled trials comparing CC with AIs are lacking.

scholarly journals The predictors of preterm labour in patients with multiple pregnancy

2020 ◽  
pp. 144-150
Author(s):  
S. V. Barinov ◽  
A. A. Belinina ◽  
O. V. Koliado ◽  
I. V. Molchanova ◽  
A. A. Shkret ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Assisted Reproductive Technologies ◽  
Preterm Labour ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Risk Groups ◽  
Reproductive Technologies ◽  
Cervical Insufficiency ◽  
Logistic Analysis ◽  
Prophylactic Measures

Introduction. The number of women with multiple pregnancy is increasing worldwide, especially in countries with a high level of health care, where assisted reproductive technologies are widely used. According to foreign studies, one third of twins are born as a result of Assisted Reproductive Technologies (ART), so only an increase in multiple pregnancy can be predicted in the future. The main obstetric problem with these pregnancies is the problem of carrying.Objective: To identify the predictors of preterm birth in patients with multiple pregnancy in order to improve monitoring and prophylactic measures among this cohort of women.Material and methods: A retrospective controlled observational study, including 154 patients with multiple pregnancies was carried out. Logistic analysis was used to identify the predictors of preterm labour.Results: The study showed that the predictors of preterm birth varied from one trimester to another. Based on the identified predictors, the predictive models for each trimester of pregnancy were compiled. Most of the identified predictors are related to obstetrical history. Risk groups formation, based on the identification of these predictors, is extremely important for qualified medical support. Prophylactic measures should be performed on the pre-conceptional stage. Pregnancy planning should be recommended only after treatment of chronic endometritis, followed by control of vaginal microflora and progesterone support. It is hardly possible to talk about the prevention of cervical insufficiency. However, cervical correction is an important factor for perinatal outcomes improving. The research suggests that the insertion of cervical pessary in women with multiple pregnancy and cervical insufficiency allows to prolong the gestational period for 7 weeks.Conclusion: a comprehensive approach of management of women with multiple pregnancy based on the prognostic scales of preterm labour, allows to reduce the preterm birth rate.

Lesioni cutanee stellate e simmetriche in un gemello “rimasto solo”

2021 ◽  
Vol 40 (6) ◽  
pp. 383-385
Author(s):  
Claudia Sciarrotta ◽  
Gregorio Serra ◽  
Mandy Schierz ◽  
Giovanni Corsello
Keyword(s):  
Twin Pregnancy ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
Intrauterine Death ◽  
Second Trimester ◽  
Aplasia Cutis Congenita ◽  
Multiple Gestations ◽  
Vanishing Twin Syndrome ◽  
Twin Pregnancies

The incidence of multiple pregnancy has increased, particularly because of the advances in assisted reproductive technologies. Multiple gestations are high risk pregnancies, especially the monochorionic ones. Two/thirds of initially twin pregnancies result in singles at birth, a condition defined as vanishing twin syndrome. The intrauterine death of one of the twins can cause direct fetal damage to the surviving one on several levels. The paper describes the case of a child born from twin pregnancy that was interrupted for one of the co-twins at early second trimester of gestation who presented with aplasia cutis congenita.

P–766 Neurodevelopment in fetuses conceived by assisted reproductive technologies following fresh and frozen embryo transfer

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M L Boutet ◽  
E Eixarch ◽  
P Ahumada-Droguett ◽  
F Crovetto ◽  
M S Cívico ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Gestational Age ◽  
Maternal Age ◽  
Assisted Reproductive Technologies ◽  
Cortical Development ◽  
Multiple Pregnancy ◽  
Fetal Brain ◽  
Reproductive Technologies ◽  
Fine Motor ◽  
Problem Solving Skills

Abstract Study question Do in vitro fertilization (IVF) offspring present different neurodevelopment assessed by fetal neurosonography and infant neurobehavioral tests as compared to those spontaneously conceived (SC)? Summary answer IVF offspring, especially those obtained after fresh embryo-transfer (ET), showed subtle structural differences in fetal neurosonography and poorer neurobehavioral scores at twelve months of age. What is known already The number of pregnancies following assisted reproductive technologies (ART) is currently increasing worldwide. Concerns about the neurodevelopment of subjects conceived by IVF have been rising and mostly studied in children and adolescents with inconsistent results. Many of the identified risk associations were only observed in subgroups or disappeared after adjustment for covariates, mainly multiple pregnancy and gestational age at birth. It is unknown whether fetal brain development and cortical folding differ prenatally in IVF fetuses as compared to SC. Study design, size, duration This is the first study examining fetal neurodevelopment by neurosonography in IVF fetuses. A prospective cohort study of 210 singleton pregnancies recruited from 2017 to 2020, including 70 SC gestations, 70 conceived by IVF following frozen ET (FET) and 70 IVF after fresh ET. Fetal neurosonography was performed in all pregnancies. Additionally, Ages & Stages Questionnaires (ASQ) were obtained at 12 months of corrected age. Participants/materials, setting, methods IVF pregnancies were recruited from a single Assisted Reproduction Center, ensuring homogeneity in IVF stimulation protocols, endometrial preparation, laboratory procedures and embryo culture conditions. SC pregnancies were randomly selected from low-risk fertile couples and paired to IVF by maternal age. Fetal neurosonography including transvaginal approach was performed at 32±2 weeks of gestation, measured off-line by a single investigator and normalized by biparietal or occipitofrontal diameter. ASQ were obtained postnatally, at 12 months of corrected age. Main results and the role of chance Study groups were similar and comparable regarding maternal age, body mass index, study level and employment rate together with exposure to smoke, alcohol, aspirin and corticoids during pregnancy, gestational age (32±2 weeks) and estimated fetal weight (1700±400g) at neurosonography. As compared to SC pregnancies, both IVF populations showed differences in cortical development with reduced parieto-occipital (fresh ET 12.5mm [SD 2.5] vs FET 13.4 [2.6] vs SC 13.4 [2.6]), cingulate (fresh ET 5.8 [IQR 4.2–7.4] vs FET 5.8 [4.1–7.5] vs SC 6.5 [4.8–7.8]) and calcarine (fresh ET 13.5 [IQR 10.1–16.1] vs FET 14.5 [12.1–15.8] vs SC 16.4 [14.3–17.9]) sulci depth together with lower Sylvian fissure grading. Cortical development changes were more pronounced in the fresh ET group as compared to FET. Corpus callosum length and insula depth were lower in FET and fresh ET groups, respectively. Neurosonographic changes remained statistically significant after adjustment by ethnicity, gender, gestational age and weight centile at scan. IVF infants showed worse ASQ scores, especially in fresh ET for communication, personal-social, fine-motor and problem-solving skills. Gross-motor scores were significantly lower in FET as compared to SC and fresh ET. Differences were statistically significant after adjustment by maternal ethnicity, study level, employment status, breastfeeding, gender and corrected age. Limitations, reasons for caution The reported neurodevelopmental differences are subtle, with most neurosonographic findings lying within normal ranges. Infertility factors contribution to the outcome cannot be unraveled from the ART procedure itself. The milder features found in FET individuals cannot condition the techniqués choice and must be considered together with their global perinatal results. Wider implications of the findings: Neurosonography is an appropriate tool to identify subtle brain differences between fetuses exposed and not exposed to ART. Prenatal features were consistent with postnatal neurobehavioral findings. These results support the relevance of a neurodevelopmental follow-up in IVF patients. Further studies are warranted to assess the long-term performance in these subjects. Trial registration number Not applicable

scholarly journals JUSTIFICATION OF CONTROL OF RECEVALESCENCE AND INDIVIDUAL REHABILITATION IN WOMEN WHO UNDERWENT SEVERE PREECLAMPSIA

2018 ◽  
Vol 25 (3) ◽  
pp. 73-81
Author(s):  
V. A. NOVIKOVA ◽  
Z. S. YUSUPOVA ◽  
O. A. SHAPOVALOVA ◽  
V. A. KHOROLSKY
Keyword(s):  
Assisted Reproductive Technologies ◽  
Diastolic Pressure ◽  
Multiple Pregnancy ◽  
Uterine Cavity ◽  
Reproductive Technologies ◽  
Severe Preeclampsia ◽  
Premature Delivery ◽  
Time Interval ◽  
Interstitial Pulmonary Edema ◽  
Perinatal Center

Aim. Justification of control of reconvalescence and individual rehabilitation in women who underwent severe preeclampsia (PE). Materials and methods. A prospective, non-randomized, controlled, open-label, nosocomial study was conducted in the period of 2016-2017. 170 women participated: 100 women with severe preeclampsia (32 – with early, 68 – with late), 70 women with moderate preeclampsia. Inclusion criteria: pre-eclampsia, singleton pregnancy, which occurred spontaneously in the natural menstrual cycle. Exclusion criteria non-obstetric pathology, by competing with the severity of pre-eclampsia, multiple pregnancy without fetal cephalic presentation, pregnancy due to assisted reproductive technologies, obstetrical pathologies, necessitating premature delivery or emergency. Results. In 70% of women the gestational age was premature. 53% of women with PE were primiparous and primgravida. Due to the atypical course of PE the time interval from the suspicion of PE to its clinical verification and delivery could reach 35 days, on average – 5,88±8,76 days before being transferred to the perinatal center. Time spent in the Perinatal Center before delivery was 3.43±2.3 days for early PE, 1.9±2.28 days for the severe late PE and 3.29±2.36 days for mild PE, was comparable. In women with severe PE critical (urgent) dysfunction of the organ (s) were diagnosed: signs of moderate pulmonary hypertension, interstitial pulmonary edema, hydrothorax; stagnant phenomena of both lungs; moderate hydrocephalus; dilatation of the left atrium; diffuse changes in the liver, pancreas, kidney parenchyma; paranephric discharge; hydroperitoneum; hydrothorax; hydropericardium. Critical multiple organ disorders due to PE in combination with delivery by cesarean section after delivery demanded staying in the intensive care ward within 2.6±1.84 days in severe PE and 1.0±1.41 days in moderate PE (p>0.05). 24% of women with severe PE after delivery under the supervision of ultrasound performed a vacuum-aspiration of the contents of the uterine cavity. The maximum time spent in the Perinatal Center after delivery was 7.65±2.34 days (5-13 days). The outpatient visits to an obstetrician-gynecologist varied from the 7th to the 15th week after the delivery. In 26% of women changes remained in the fundus (retinopathy, retinal angiopathy) and 35% - neurological symptoms (encephalopathy) of varying severity. In 16% of women d arterial hypertension with values of diastolic pressure more than 90 mm Hg was preserve. Conclusion. It is necessary to ensure the rehabilitation of women who have undergone severe PE, not only after delivery in a perinatal center, but also at an outpatient stage under supervision of related specialists. In the presence of fertile plans, individualized pregravid and preconception preparation is required with consideration of the nature of the scar on the uterus undergone instrumental uterine evacuation, specialized supervision by related professionals.

scholarly journals All the right moves: why in utero transfer is both important for the baby and difficult to achieve and new strategies for change

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 979
Author(s):  
Helena Watson ◽  
James McLaren ◽  
Naomi Carlisle ◽  
Nandiran Ratnavel ◽  
Tim Watts ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Transfer Process ◽  
Assisted Reproductive Technologies ◽  
Clinical Care ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
In Utero ◽  
The Uk ◽  
The Right ◽  
The Impact

The best way to ensure that preterm infants benefit from relevant neonatal expertise as soon as they are born is to transfer the mother and baby to an appropriately specialised neonatal facility before birth (“in utero”). This review explores the evidence surrounding the importance of being born in the right unit, the advantages of in utero transfers compared to ex utero transfers, and how to accurately assess which women are at most risk of delivering early and the challenges of in utero transfers. Accurate identification of the women most at risk of preterm birth is key to prioritising who to transfer antenatally, but the administrative burden and pathway variation of in utero transfer in the UK are likely to compromise optimal clinical care. Women reported the impact that in utero transfers have on them, including the emotional and financial burdens of being transferred and the anxiety surrounding domestic and logistical concerns related to being away from home. The final section of the review explores new approaches to reforming the in utero transfer process, including learning from outside the UK and changing policy and guidelines. Examples of collaborative regional guidance include the recent Pan-London guidance on in utero transfers. Reforming the transfer process can also be aided through technology, such as utilising the CotFinder app. In utero transfer is an unavoidable aspect of maternity and neonatal care, and the burden will increase if preterm birth rates continue to rise in association with increased rates of multiple pregnancy, advancing maternal age, assisted reproductive technologies, and obstetric interventions. As funding and capacity pressures on health services increase because of the COVID-19 pandemic, better prioritisation and sustained multi-disciplinary commitment are essential to maximise better outcomes for babies born too soon.

scholarly journals Twin pregnancy, fetal reduction and the 'all or nothing problem’

2020 ◽  
pp. medethics-2020-106938
Author(s):  
Joona Räsänen
Keyword(s):  
Moral Theory ◽  
Twin Pregnancy ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
In Vitro Fertilisation ◽  
Singleton Pregnancy ◽  
Fetal Reduction ◽  
Health Related

Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin pregnancy. I argue that in the case of a twin pregnancy, there are two intuitively plausible claims: (1) abortion is morally permissible, and (2) it is morally wrong to abort just one of the fetuses. But since we should choose morally permissible acts rather than impermissible ones, the two claims lead to another highly implausible claim: the woman ought to abort both fetuses rather than only one. Yet, this does not seem right. A plausible moral theory cannot advocate such a pro-death view. Or can it? I suggest ways to solve this problem and draw implications for each solution.

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