Neonatal Morbidity of Monoamniotic Twin Pregnancies: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Danilo Buca ◽  
Daniele Di Mascio ◽  
Asma Khalil ◽  
Ganesh Acharya ◽  
Tim Van Mieghem ◽  
...  
Keyword(s):  
Gestational Age ◽  
Primary Outcome ◽  
Random Effect ◽  
Neonatal Morbidity ◽  
Small Sample ◽  
Respiratory Morbidity ◽  
Infectious Morbidity ◽  
Neurological Morbidity ◽  
Twin Pregnancies ◽  
Type Of Management

Objective This study was aimed to report the incidence of neonatal morbidity in monochorionic monoamniotic (MCMA) twin pregnancies according to gestational age at birth and type of management adopted (inpatient or outpatient). Study Design Medline and Embase databases were searched. Inclusion criteria were nonanomalous MCMA twins. The primary outcome was a composite score of neonatal morbidity, defined as the occurrence of at least one of the following outcomes: respiratory morbidity, overall neurological morbidity, severe neurological morbidity, and infectious morbidity, necrotizing enterocolitis at different gestational age windows (24–30, 31–32, 33–34, and 35–36 weeks). Secondary outcomes were the individual components of the primary outcome and admission to neonatal intensive care unit (NICU). Subanalysis according to the type of surveillance strategy (inpatient compared with outpatient) was also performed. Random effect meta-analyses were used to analyze the data. Results A total of 14 studies including 685 MCMA twin pregnancies without fetal anomalies were included. At 24 to 30, 31 to 32, 33 to 34, and 35 to 36 weeks of gestation, the rate of composite morbidity was 75.4, 65.5, 37.6, and 18.5%, respectively, the rate of respiratory morbidity was 74.2, 59.1, 35.5, and 12.2%, respectively, while overall neurological morbidity occurred in 15.3, 10.2, 4.3, and 0% of the cases, respectively. Infectious morbidity complicated 13, 4.2, 3.1, and 0% of newborns while 92.1, 81.6, 58.7, and 0% of cases required admission to NICU. Morbidity in pregnancies delivered between 35 and 36 weeks of gestation was affected by the very small sample size of cases included. When comparing the occurrence of overall morbidity according to the type of management (inpatient or outpatient), there was no difference between the two surveillance strategies (p = 0.114). Conclusion MCMA pregnancies are at high risk of composite neonatal morbidity, mainly respiratory morbidity that gradually decreases with increasing gestational age at delivery with a significant reduction for pregnancies delivered between 33 and 34 weeks. We found no difference in the occurrence of neonatal morbidity between pregnancies managed as inpatient or outpatient. Key Points

Association between the Degree of Twin Birthweight Discordance and Perinatal Outcomes

2018 ◽  
Vol 36 (09) ◽  
pp. 969-974 ◽  
Author(s):  
Lena H. Kim ◽  
Aaron B. Caughey ◽  
Lynn M. Yee ◽  
Yvonne W. Cheng
Keyword(s):  
Neonatal Intensive Care ◽  
Primary Outcome ◽  
Random Effect ◽  
Birth Certificate ◽  
Perinatal Outcomes ◽  
Neonatal Morbidity ◽  
Vital Statistics ◽  
Adverse Outcomes ◽  
Neonatal Seizure ◽  
Breech Delivery

Background Twin birthweight discordance is associated with adverse outcomes. Objective To determine what degree of twin birthweight discordance is associated with adverse outcomes. Study Design This is a retrospective cohort study of twins with vertex twin A delivered vaginally at 36 to 40 weeks (U.S. Vital Statistics Natality birth certificate registry data 2012–2014). The primary outcome was a composite of neonatal morbidity: 5-minute Apgar < 7, neonatal intensive care unit admission, neonatal mechanical ventilation > 6 hours, neonatal seizure, and/or neonatal transport to a higher level of care. Effect estimates were expressed as incidence rate and adjusted odds ratio (aOR) controlling for confounding using multivariate clustered analysis for between-pair effects, and multilevel random effect generalized estimating equation regressions to account for within-pair effects. We adjusted for sex discordance, breech delivery of the second twin, maternal race/ethnicity, nulliparity, age, marital status, obesity, and socioeconomic status. Results In comparison to birthweight discordance of ≤20%, aORs with 95% confidence intervals (CIs) by weight discordance of the primary outcome among 27,276 twin deliveries were as follows: 20.01 to 25% (aOR: 1.46 [95% CI: 1.29–1.65]); 25.01 to 30% (aOR: 1.96 [95% CI: 1.68–2.29]); and 30.01 to 60% (aOR: 2.97 [95% CI: 2.52–3.50]). Conclusion Twin birthweight discordance >20% was associated with increased odds of adverse neonatal outcome.

scholarly journals Pregnancy Outcome of Twin Pregnancy at Gandaki Medical College Teaching Hospital, Pokhara, Nepal

2018 ◽  
Vol 11 (02) ◽  
pp. 1-4
Author(s):  
M Tripathi ◽  
R Shrestha
Keyword(s):  
Preterm Delivery ◽  
Teaching Hospital ◽  
Gestational Age ◽  
Twin Pregnancy ◽  
College Teaching ◽  
Neonatal Morbidity ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Neonatal Complications ◽  
Twin Pregnancies

Objectives: To evaluate maternal and neonatal complications and pregnancy outcomes of twin pregnancies. Methods: The cross sectional study was conducted using retrospective data on the twin pregnancies with more than 28 weeks of gestational age. The study used data over a period of five years, from March 10, 2010 to March 9, 2015 in the Department of Obstetrics and Gynecology, GMC Teaching Hospital Pokhara. Results: Of the 50 twin pregnancies, the most common maternal complication was preterm delivery (40%). Other maternal complications were anemia (36%), pregnancy induced hypertension (14%), premature rupture of membranes (14%), postpartum hemorrhage (12%) and antepartum hemorrhage (6%). Median gestational age at delivery was 37 weeks. Most common route of delivery was cesarean section (66%). Most common neonatal complication was low birth weight (48%) births first twin and second twin 56%. Conclusion: Twin pregnancy has high maternal and neonatal complications, especially preterm delivery that increases the risk of significant neonatal morbidity and mortality.

scholarly journals Twin-Twin Transfusion Syndrome with Anemia-Polycythemia: Prevalence, Characteristics, and Outcome

2019 ◽  
Vol 8 (8) ◽  
pp. 1129 ◽  
Author(s):  
Lisanne S. A. Tollenaar ◽  
Femke Slaghekke ◽  
Jeanine M. M. van Klink ◽  
Sophie G. Groene ◽  
Johanna M. Middeldorp ◽  
...  
Keyword(s):  
Laser Surgery ◽  
Primary Outcome ◽  
Disease Free Survival ◽  
Peak Systolic Velocity ◽  
Neonatal Morbidity ◽  
Free Survival ◽  
Neurodevelopmental Impairment ◽  
Twin Pregnancies ◽  
Disease Free ◽  
Perinatal Survival

The aim of this study was to estimate the prevalence of co-existing anemia-polycythemia (AP) in twin pregnancies with twin-twin transfusion syndrome (TTTS) prior to laser surgery, and to evaluate the characteristics and outcomes in TTTS twins with and without AP. All TTTS cases treated with laser between 2001 and 2019 were retrospectively reviewed for the presence of AP before surgery. AP was defined as delta middle cerebral artery–peak systolic velocity > 0.5 multiples of the median. The primary outcome was a composite of perinatal survival and severe neurodevelopmental impairment (NDI). Secondary outcomes included procedure-related characteristics, severe neonatal morbidity, and disease-free survival. In total, 66% (461/696) of TTTS twin pregnancies were eligible for analysis. AP was detected in 15% (70/461) of the TTTS twins prior to laser surgery. Gestational age at laser was higher in the TTTS+AP group compared to the TTTS-only group—21.0 weeks (interquartile rage (IQR): 18.8–24.0) versus 19.3 weeks (IQR: 17.3–21.9), respectively (p < 0.0001). Fewer placental anastomoses were detected in the TTTS+AP group than in the TTTS-only group—five (IQR: 4–6) versus six (IQR: 5–8), respectively (p < 0.0001). Perinatal survival was 77% (599/782) in the TTTS-only group and 83% (118/142) in the TTTS+AP group (p = 0.130). Severe NDI was 8% (28/370) in TTTS-only and 3% (2/74) in TTTS+AP. TTTS-only twins showed more severe neonatal morbidity than twins with TTTS+AP—23% (132/575) versus 11% (13/115), respectively (p = 0.005). Disease-free survival was lower in the TTTS-only group compared to the TTTS+AP group—62% (341/548) versus 73% (72/98), respectively (p = 0.046). Thus, AP complicates 15% of TTTS twins prior to laser. TTTS+AP twins show a different placental angioarchitecture, a later time of onset of the disease, and a more favorable outcome.

Twin Anemia-Polycythemia Sequence: Perinatal Management and Outcome

2015 ◽  
Vol 40 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Eran Ashwal ◽  
Yoav Yinon ◽  
Michal Fishel-Bartal ◽  
Abraham Tsur ◽  
Benjamin Chayen ◽  
...  
Keyword(s):  
Gestational Age ◽  
Neonatal Morbidity ◽  
Control Group ◽  
Monochorionic Twins ◽  
Monochorionic Twin ◽  
Gestational Age At Delivery ◽  
Perinatal Management ◽  
Intrauterine Blood Transfusion ◽  
And Control ◽  
Twin Pregnancies

Objective: To determine the perinatal outcome of monochorionic twin pregnancies complicated by twin anemia-polycythemia sequence (TAPS). Methods: All monochorionic twins diagnosed with TAPS between 2011 and 2014 were included. Each twin pair with TAPS (study group) was compared with 2 uncomplicated monochorionic twin pairs who were matched for gestational age at delivery (control group). Neonatal morbidity and mortality were evaluated. Results: During the study period, 179 monochorionic twins were followed at our center, of whom 46 underwent laser ablation due to twin-to-twin transfusion syndrome. TAPS was diagnosed in 10 cases; 8 of them were spontaneous, and 2 occurred following laser surgery. Out of 7 patients diagnosed prenatally with TAPS, 5 cases were managed expectantly, and 2 cases were treated with intrauterine blood transfusion. The rates of severe and mild central nervous system lesions on postnatal ultrasound were similar in the TAPS group and control group (5.0 vs. 2.5%, p = 0.61, and 5.0 vs. 12.5%, p = 0.25, respectively). Additionally, severe neonatal morbidity was comparable between the groups. All neonates were alive at 1 month of age. Conclusion: The neonatal outcome of monocohorionic twins affected by TAPS is favorable and comparable to gestational age-matched uncomplicated monochorionic twins.

scholarly journals Is there a Role for Antenatal Corticosteroids in Term Infants before Elective Cesarean Section?

2021 ◽  
Vol 43 (04) ◽  
pp. 283-290
Author(s):  
Augusta Arruda ◽  
Mariana Ormonde ◽  
Sarah Stokreef ◽  
Beatriz Fraga ◽  
Catarina Franco ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Gestational Age ◽  
Statistical Significance ◽  
Neonatal Morbidity ◽  
Exposed Group ◽  
Neonatal Outcomes ◽  
Elective Cesarean Section ◽  
Respiratory Morbidity ◽  
Antenatal Corticosteroids ◽  
Term Infants

Abstract Objective Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. Methods The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders. Results A total of 334 newborns met the inclusion criteria. One third of the population study (n = 129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR] = 1.250; 95% confidence interval [CI]: 0.454–3.442), transient TTN (OR = 1.,623; 95%CI: 0.556–4.739), and NIUC admission (OR = 2.155; 95%CI: 0.474–9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR = 0,732; 95%CI: 0.240–2.232), TTN (OR = 0.959; 95%CI: 0.297–3.091), and NIUC admission (OR = 0,852; 95%CI: 0.161–4.520) become lower in the ACS exposed group. Conclusion Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

scholarly journals The Impact of Timing of Elective Cesarean Delivery at Term in Neonatal Respiratory Morbidity.

2020 ◽  
Vol 4 (2) ◽  
pp. 653-660
Author(s):  
Ajmone TROSHANI ◽  
Evda VEVECKA
Keyword(s):  
Caesarean Section ◽  
Gestational Age ◽  
Primary Outcome ◽  
Elective Caesarean Section ◽  
Respiratory Morbidity ◽  
Emergency Caesarean ◽  
Emergency Cesarean ◽  
Increased Risk ◽  
Elective Cesarean ◽  
The Impact

The aim is to investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections Methods; Cohort study with prospectively collected data of all elective Caesarean sections on mothers with a gestational age of 37+0 weeks and more, that were performed in our Hospital from 1 January 2011 to 1 January 2017. Multiple pregnancies, fetuses with congenital anomalies, intrauterine deaths, and emergency Caesarean sections were excluded. Primary outcome measures of neonatal respiratory morbidity included transient tachypnea of newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn. Results; 4290 infants were delivered by elective caesarean section at 37+0 and then after Compared with newborns from vaginal delivery, and emergency cesarean section an increased risk of respiratory morbidity was found for infants delivered by elective caesarean section at 37 +0 weeks’ gestation to 37+6 weeks (odds ratio 5.7 95% confidence interval 4.3 to 8.9), 38+0 weeks’ gestation to 38+6 weeks (2.8, 2.1 to 4.2 ), and 39+0 weeks’ gestation (2.1, 1.5 to 2.8). Also increasing the incidence of admission to the NICU with decreasing gestational age at term birth below the 39 weeks of gestation Conclusions: Compared with newborn delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of respiratory morbidity. The relative risk increased with decreasing gestational age.

Neonatal Outcomes Differ after Spontaneous and Indicated Preterm Birth

2017 ◽  
Vol 35 (05) ◽  
pp. 494-502 ◽  
Author(s):  
Devyn Demaree ◽  
Emily Merfeld ◽  
Methodius Tuuli ◽  
Jennifer Wambach ◽  
F. Cole ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Labor ◽  
Primary Outcome ◽  
Neonatal Morbidity ◽  
Neonatal Outcomes ◽  
Respiratory Morbidity ◽  
Preterm Neonates ◽  
Medical Complication ◽  
Respiratory Outcomes ◽  
Preterm Rupture Of Membranes

Objective Preterm birth (PTB) at <37 weeks of gestation complicates 10% of pregnancies and requires accurate counseling regarding anticipated neonatal outcomes. PTB classification as spontaneous or indicated is commonly used to cluster PTB into subtypes, but whether neonatal outcomes differ by PTB subtype is unknown. We tested the hypothesis that neonatal morbidity differs based on subtype of PTB. Methods We performed a retrospective cohort study of live-born, non-anomalous preterm infants from 2004 to 2008. Spontaneous PTB was defined as PTB from spontaneous preterm labor or preterm rupture of membranes. Indicated PTB was defined as PTB from any maternal or fetal medical complication necessitating delivery. The primary outcome was a composite of early respiratory morbidity. Secondary outcomes included late composite respiratory morbidity and other neonatal morbidities. Results Of 1,223 preterm neonates, 60.9% were born after spontaneous PTB and 30.1% after indicated PTB. Composite early respiratory morbidity was significantly higher after indicated PTB versus spontaneous PTB (1.3, 95% confidence interval [CI] 1.2–1.4). Composite late respiratory morbidity (1.8, 95% CI 1.3–2.3) and neonatal death (2.8, 95% CI 1.5–5.1) were also significantly higher after indicated PTB versus spontaneous PTB. Conclusion Neonatal respiratory outcomes and death differ according to PTB subtype. PTB subtype should be considered while counseling families and anticipating neonatal outcomes after PTB.

Population versus Customized Growth Curves: Prediction of Composite Neonatal Morbidity

2018 ◽  
Vol 36 (08) ◽  
pp. 818-827 ◽  
Author(s):  
Hector Mendez-Figueroa ◽  
Suneet P. Chauhan ◽  
Tyisha Barrett ◽  
Van Thi Thanh Truong ◽  
Claudia Pedroza ◽  
...  
Keyword(s):  
Gestational Age ◽  
Random Effect ◽  
Perinatal Outcomes ◽  
Growth Curves ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Large For Gestational Age ◽  
Likelihood Ratios ◽  
Maternal Fetal Medicine ◽  
Adverse Perinatal Outcomes

Objective To assess the ability of customized and population growth nomograms in identifying newborns with composite neonatal morbidity (CNM). Study Design This study included women who participated in the 10 Maternal-Fetal Medicine Units (MFMU) trials and delivered a nonanomalous singleton with a known gestational age (GA) of 24 weeks or more and documented birthweight. Population nomograms were based on Alexander's nomogram, whereas customized nomograms used publicly available softwares. Random-effect logistic regression was used to estimate the adjusted odds ratio (aOR). Positive and negative likelihood ratios (LRs) were calculated to assess nomogram performance. Results Of 92,225 women, 85% met the inclusion criteria. Using the population nomogram, 12% were small for gestational age (SGA) and 10% were large for gestational age (LGA), and using customized nomograms, 15% were SGA and 16% LGA. SGA newborns had a higher likelihood of CNM (aOR: 2.62; 95% confidence interval [CI]: 2.48–2.76) for population nomograms and 3.22 (95% CI: 3.07–3.39) for customized nomograms. LGA newborns had a similar CNM with population nomogram but significantly higher with customized nomogram (aOR: 1.42; 95% CI: 1.34–1.50). For the adverse outcomes among SGA and LGA, the positive LRs for the two nomograms were similar with overlapping 95% CI. Conclusion Though both SGA and LGA are associated with adverse perinatal outcomes, the detection using both nomograms was similar.

scholarly journals Morbilidade Neonatal e Cesariana Electiva em Recém-Nascidos de Termo

2015 ◽  
Vol 28 (5) ◽  
pp. 601 ◽  
Author(s):  
Maria Cristina Resende ◽  
Lea Santos ◽  
Isabel Santos Silva
Keyword(s):  
Gestational Age ◽  
Odds Ratio ◽  
Neonatal Intensive Care ◽  
Neonatal Morbidity ◽  
Elective Cesarean Section ◽  
Respiratory Morbidity ◽  
Cesarean Sections ◽  
Feeding Difficulties ◽  
Elective Cesarean ◽  
Term Newborns

<strong>Introduction:</strong> International guidelines suggest that non-urgent planned deliveries be scheduled at or after 39 weeks. Despite this recommendation elective cesarean often occurs before 39 weeks. Some research has demonstrated that elective cesarean before 39 weeks poses a greater risk to the infants than at or after 39 weeks.<br /><strong>Objective:</strong> To evaluate neonatal morbidity in term newborns born by elective cesarean section.<br /><strong>Material and Methods:</strong> Retrospective study of all term elective cesarean sections (scheduled and without labor) performed in level III maternity, in the last 11 years (2003 - 2013). High risk pregnancies were excluded: twins, premature rupture of membranes, preeclampsia, poorly controlled diabetes mellitus, Rh isoimmunization and congenital malformations. Two groups of newborns with gestational age less than 39 weeks and equal or greater than 39 weeks gestational age were compared.<br /><strong>Results:</strong> In our sample, 45% of elective caesarean sections were performed before 39 weeks. Infants born before 39 weeks were more frequently admitted in neonatal intensive care, odds ratio 2.4 [1.4 – 4.1] p = 0.001, had more respiratory morbidity, odds ratio 2.4 [1.6 - 3.8] p &lt; 0.001, more hyperbilirubinaemia odds ratio 2.3 [1.5 – 3.7] p &lt; 0.001, more hypoglycaemia and/or feeding difficulties odds ratio 1.6 [1.2 – 2.4] p = 0.006, and longer admissions (more than five days), odds ratio 2.0 [1.4 - 3] p &lt; 0.001.<br /><strong>Discussion:</strong> As in other studies ‘early term’ had higher respiratory and metabolic morbidity and consequently had a longer hospital stay.<br /><strong>Conclusion:</strong> These findings support recommendations to delay elective cesarean delay until 39 weeks of gestation.

Are neonatal outcomes of triplet pregnancies different from those of singletons according to gestational age?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Georgios Mitsiakos ◽  
Dimitra Gialamprinou ◽  
Ilias Chatziioannidis ◽  
Abraham Pouliakis ◽  
Christos Georgios Kontovazainitis ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Neonatal Morbidity ◽  
Neonatal Outcomes ◽  
Multiple Pregnancies ◽  
Extreme Prematurity ◽  
Significant Difference

ABSTRACT Objectives Multiple pregnancies sustain the high pace of extreme prematurity. Little evidence is available about triplet gestation given the evolution in their management during the last decades. The aim of the study was to compare the neonatal outcomes of triplets with those of matched singletons in a cohort study. Methods An observational retrospective cohort study of triplets and matched singletons born between 2004 and 2017 matched by gestational age was conducted. Additionally, the investigation performed in regard to data from the overall Greek population of interest. The primary outcome was mortality or severe neonatal morbidity based on pregnancy type. Results A total of 237 triplets of 24–36 weeks’ gestation and 482 matched singletons were included. No differences in the primary outcome between triplets and singletons were found. Rates of severe neonatal morbidities did not differ significantly between triplets and singletons. A threshold of 1000 gr for birthweight and 28 weeks’ gestation for gestational age determined survival on triplets [OR: 0.08 (95% CI: 0.02–0.40, p=0.0020) and OR: 0.13 (95% CI: 0.03–0.57, p=0.0020) for gestational age and birthweight respectively]. In Greece stillbirths in triplets was 8 times higher than that of singletons (OR: 8.5, 95% CI: 6.9–10.5). From 3,375 triplets, 94 were stillborn, whereas in singletons, 4,659 out of 1,388,273. In our center 5 times more triplets than the expected average in Greece were delivered with no significant difference in stillbirths’ rates. Conclusions No significant differences were identified in mortality or major neonatal morbidities between triplets and matched singletons highlighting the significance of prematurity and birthweight for these outcomes.

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