MANAGEMENT CONUNDRUMS IN MULTIPLE PREGNANCIES WITH SELECTIVE REDUCTION, INTRAUTERINE FETAL DEATH OR SPONTANEOUS ABORTION

2009 ◽  
Vol 20 (3) ◽  
pp. 247-267
Author(s):  
RITU MOGRA ◽  
DAVID LH MOORE ◽  
JON A HYETT
Keyword(s):  
Perinatal Mortality ◽  
Fetal Death ◽  
Selective Reduction ◽  
Fold Increase ◽  
Mortality Rates ◽  
Intrauterine Fetal Death ◽  
Multiple Pregnancies ◽  
Delayed Childbearing ◽  
Reproductive Techniques ◽  
The Uk

There has been a marked increase in the prevalence of twins, triplets and higher-order multiple pregnancies over the last 20 years due, in part, to delayed childbearing, but more significantly associated with the widespread introduction of assisted reproductive techniques. Once viability is confirmed these pregnancies pose a series of unique challenges to the obstetrician as the dynamic of the maternal – fetal relationship changes when there are two, or more, fetuses to consider. With the exception of postmaturity, all obstetric complications are more common in multiple pregnancies. Australian data shows perinatal mortality rates of 7, 25 and 63 per 1,000 births for singleton, twin (RR 3.4) and triplet (RR 8.5) pregnancies respectively; with similar rates reported in the UK and USA. While multiple pregnancies account for only 2% of births, they account for 20% of neonatal admissions and 12% of perinatal deaths – with a 5-fold increase in deaths before 1 year of age.

TYPE 1 DIABETES IN PREGNANCY; INFLUENCES ON MOTHER AND FETUS

2009 ◽  
Vol 20 (1) ◽  
pp. 17-47 ◽  
Author(s):  
SCOTT M NELSON ◽  
ROBERT S LINDSAY
Keyword(s):  
Type 1 Diabetes ◽  
Perinatal Mortality ◽  
Glucose Monitoring ◽  
Perinatal Outcomes ◽  
Fold Increase ◽  
Gradual Improvement ◽  
Management Of Complications ◽  
The Uk ◽  
Very High

Type 1 diabetes complicates around 1 in 200 to 300 pregnancies in the United Kingdom. Historically maternal type 1 diabetes carried very high risks for mother and child. Introduction of insulin led to an immediate, marked decline in the previously very high rates of maternal mortality; in contrast an improvement in perinatal outcomes occurred more slowly but was nevertheless dramatic. This is strikingly demonstrated by the temporal decline in perinatal mortality in offspring of mothers with type 1 diabetes which was virtually universal before use of insulin in the 1920's, likely remained in excess of 20% even in the 1960's and fell to under 4% by the 1990's. The reasons for this more gradual improvement in perinatal outcomes cannot be defined with precision but will have been influenced by improved glycaemic management with use of intensive, multiple dose insulin treatment and home glucose monitoring; improvements in obstetric and neonatal management, and better management of complications of diabetes before and during pregnancy. In 1989 the St Vincent declaration proposed that pregnancy outcomes in women with type 1 diabetes should approximate those of the non-diabetic population. While the long term improvements in fetal outcomes have been dramatic, contemporary surveys confirm a persistent doubling or more of rates of congenital anomaly and a three to four fold increase in perinatal mortality in the UK and other European countries which will require further clinical innovation to overcome.

scholarly journals Antenatal fetal death in multiple pregnancy: is early prediction possible?

2021 ◽  
Vol 14 (6) ◽  
pp. 602-611
Author(s):  
V. I. Tsibizova ◽  
D. V. Blinov ◽  
V. O. Bitsadze ◽  
T. M. Pervunina ◽  
E. V. Komlichenko ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Reference Values ◽  
Fetal Death ◽  
Multiple Pregnancy ◽  
First Trimester ◽  
Multiple Pregnancies ◽  
Vitro Fertilization ◽  
Diagnostic Potential ◽  
Increased Risk

Introduction. Perinatal mortality in multiple pregnancies increases by 8–10 times compared to singletons. Stillbirth is a significant part of all complications of multiple pregnancies. Although the incidence of perinatal mortality in multiple pregnancies has decreased consistently compared to extremely high rates in the past, it remains relatively high, despite significant positive changes in the management of such pregnancies. Aim: to assess the diagnostic potential of the first trimester's biochemical screening in multiple pregnancies for predicting antenatal fetal death. Materials and Methods. As part of a retrospective study, a cohort of twin pregnancies after in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or spontaneous conception underwent screening of the first trimester at 11+0–13+6 weeks of gestation as recommended by the Fetal Medicine Foundation. Determination of pregnancy-associated plasma protein-A (PAPP-A) in blood serum with subsequent calculation of the relative PAPP-A MoM (multiples of median) – a multiple of the median (an indicator of how much the individual test result deviates from the reference values) was performed. Results. Prenatal screening and outcomes of 302 multiple pregnancies showed that with PAPP-A MoM < 0.5, antenatal fetal death occurred with a frequency of 42.86 % (6/14), with PAPP-A MoM within the reference values – In 12.67 % (28/221), with PAPP-A MoM > 2.0 – in 6.7 % (2/30). Differences between patients with PAPP-A MoM < 0.5 and PAPP-A MoM within the reference values, as well as PAPP-A MoM < 0.5 and PAPP-A MoM > 2.0 were statistically significant (p = 0.002 and p = 0.004, respectively). No differences were detected between spontaneous and assisted reproductive technology (ART) pregnancies. Conclusion. In women with multiple pregnancies resulting from ART or spontaneous, PAPP-A MoM values below the reference interval (< 0.5) in the first trimester are associated with an increased risk of antenatal fetal death.

Disentanglement of Discordant Monochorionic-Monoamniotic Twins in a Triplet Pregnancy: An Innovative Approach Utilizing Fetoscopic Laser Coagulation with Micro-Laparoscopic Scissor Dissection

2015 ◽  
Vol 40 (4) ◽  
pp. 303-305
Author(s):  
Nadia B. Kunzier ◽  
Baraa Allaf ◽  
Martin R. Chavez ◽  
Diana Abenanti-Richmond ◽  
Anthony M. Vintzileos
Keyword(s):  
Umbilical Cord ◽  
Fetal Death ◽  
Neurological Injury ◽  
Intrauterine Fetal Death ◽  
Laser Coagulation ◽  
Perinatal Morbidity ◽  
Multiple Pregnancies ◽  
Triplet Pregnancy ◽  
Increased Risk ◽  
Fetoscopic Laser Coagulation

Triplet gestations are associated with high perinatal morbidity. Dichorionic-diamniotic triplet pregnancies with growth discordance, polyhydramnios and structural anomalies carry a significantly increased risk of fetal morbidity and mortality from the baseline risks of high-order multiple pregnancies. Intrauterine fetal death of one fetus of a monochorionic pregnancy may cause neurological injury to the surviving fetus. We present a case where an innovative technique was created combining use of the fetoscopic laser and miniature laparoscopic instruments to selectively reduce and disentangle the umbilical cord of the acranial growth-restricted fetus from the structurally normal fetus's umbilical cord in a dichorionic-diamniotic triplet pregnancy.

Incidence and Costs of Multifetal Pregnancies in Andalusia (2000–2010)

2011 ◽  
Vol 14 (5) ◽  
pp. 484-489 ◽  
Author(s):  
Ernesto González Mesa ◽  
José Alberto Herrera Peral
Keyword(s):  
Assisted Reproduction ◽  
Health Care Spending ◽  
Multiple Pregnancies ◽  
Delayed Childbearing ◽  
Assisted Reproduction Techniques ◽  
The Past ◽  
Multiple Gestations ◽  
Two Factors ◽  
Reproductive Techniques ◽  
Implantation And Pregnancy Rates

In the past 50 years the incidence of multiple pregnancies has increased dramatically due almost exclusively to two factors: delayed childbearing and assisted reproductive techniques. In this paper we analyze the variations in the incidence of multiple gestations in Andalusia, one of the biggest administrative regions in Spain, over the last decade. Assisted reproduction techniques are very often evaluated only in terms of implantation and pregnancy rates per cycle, ignoring everything related to complications of multiple births, prematurity or economic overload. The rate of twins in Andalusia has increased from 10.9 per thousand in 2000 to 16.2 per thousand in 2009. The rate of triplet births has also increased in recent years. After a decline in 2003, motivated by promulgation of the first Human Assisted Reproduction Law, there was an increase after a second law came into effect in 2006. Health care spending attributable to the excess of multiple pregnancies reported in the decade 2000–2010 may have been much higher than €25 million.

Modern aspects of tactics in the genital herpes viral infection (literature review)

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (2) ◽  
pp. 67-73
Author(s):  
T Yu Pestrikova ◽  
E A Yurasova ◽  
I V Yurasov ◽  
A V Kotelnikova
Keyword(s):  
Literature Review ◽  
Viral Infection ◽  
Genital Herpes ◽  
Fetal Death ◽  
Malignant Tumors ◽  
Adult Population ◽  
Viral Disease ◽  
Intrauterine Fetal Death ◽  
Complicated Course ◽  
Simplex Virus

Genital herpes affects all population groups. 98% of the adult population worldwide have antibodies to the herpes simplex virus (HSV-1 or 2). This viral infection is a significant medical and social problem. HSV can lead to a complicated course of pregnancy, causing miscarriages, premature birth, intrauterine fetal death, systemic viral disease in newborns. There is evidence that HSV has a connection with malignant tumors of the prostate and cervix, contributing to their development. This literature review contains modern aspects of epidemiology, etiology, pathogenesis, clinic, diagnosis, treatment of genital herpes, including its recurring forms with valacyclovir (Valvir). Indications for hospitalization of patients with genital herpes were noted and the prognosis of this pathology was determined. The tactics of managing pregnant women with this pathology is presented.

Prenatal particulate matter exposure and Intrauterine Fetal Death

2021 ◽  
Vol 234 ◽  
pp. 113720
Author(s):  
Tamar Wainstock ◽  
Israel Yoles ◽  
Ruslan Sergienko ◽  
Itai Kloog ◽  
Eyal Sheiner
Keyword(s):  
Particulate Matter ◽  
Fetal Death ◽  
Intrauterine Fetal Death ◽  
Particulate Matter Exposure

scholarly journals An exploration of migrant women’s perceptions of public health messages to reduce stillbirth in the UK: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomasina Stacey ◽  
Melanie Haith-Cooper ◽  
Nisa Almas ◽  
Charlotte Kenyon
Keyword(s):  
Public Health ◽  
Perinatal Mortality ◽  
Health Professionals ◽  
Health Messages ◽  
Migrant Women ◽  
Global Public Health ◽  
Wide Range ◽  
Public Health Messages ◽  
Associated Risk Factors ◽  
The Uk

Abstract Background Stillbirth is a global public health priority. Within the United Kingdom, perinatal mortality disproportionately impacts Black, Asian and minority ethnic women, and in particular migrant women. Although the explanation for this remains unclear, it is thought to be multidimensional. Improving perinatal mortality is reliant upon raising awareness of stillbirth and its associated risk factors, as well as improving maternity services. The aim of this study was to explore migrant women’s awareness of health messages to reduce stillbirth risk, and how key public health messages can be made more accessible. Method Two semi-structured focus groups and 13 one to one interviews were completed with a purposive sample of 30 migrant women from 18 countries and across 4 NHS Trusts. Results Participants provided an account of their general awareness of stillbirth and recollection of the advice they had been given to reduce the risk of stillbirth both before and during pregnancy. They also suggested approaches to how key messages might be more effectively communicated to migrant women. Conclusions Our study highlights the complexity of discussing stillbirth during pregnancy. The women in this study were found to receive a wide range of advice from family and friends as well as health professionals about how to keep their baby safe in pregnancy, they recommended the development of a range of resources to provide clear and consistent messages. Health professionals, in particular midwives who have developed a trusting relationship with the women will be key to ensuring that public health messages relating to stillbirth reduction are accessible to culturally and linguistically diverse communities.

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