Single Center Outcome of Multiple Births in the Premature and Very Low Birth Weight Cohort in Singapore

2020 ◽  
Author(s):  
Amudha Jayanthi Anand ◽  
Karthik Sabapathy ◽  
Bhavani Sriram ◽  
Victor Samuel Rajadurai ◽  
Pratibha Keshav Agarwal
Keyword(s):  
Neonatal Mortality ◽  
Low Birthweight ◽  
Ductus Arteriosus ◽  
Multiple Pregnancy ◽  
Neonatal Morbidity ◽  
Reproductive Technologies ◽  
Multiple Births ◽  
Mortality And Morbidity ◽  
Group 2 ◽  
Group 1

Objective The aim of this study is to compare neonatal mortality and morbidity in multiple and singleton preterm/very low birthweight (PT/VLBW) multiethnic Asian infants. Study Design Cohort study of 676 singleton and 299 multiple PT/VLBW infants born between 2008 and 2012 at KK Women's and Children's Hospital, the largest tertiary perinatal center in Singapore with further stratification by gestational ages 23 to 25 (Group 1), 26 to 28 (Group 2), and ≥29 (Group 3) weeks. Outcome measures included predischarge mortality and major neonatal morbidity. Results Overall survival to discharge was comparable for singletons 611/676 (90%) and multiples 273/299 (91%). Use of assisted reproductive technologies (47 vs. 4%), antenatal steroids (80 vs. 68%), and delivery by cesarean section (84 vs. 62%) were significantly higher (p < 0.001) in multiples while pregnancy induced hypertension (8.7 vs. 31.6%, p < 0.001) and maternal chorioamnionitis (31 vs. 41%, p < 0.01) were seen less commonly compared with singleton pregnancies. Survival was comparable between singletons and multiples except for a lower survival in multiples in Group 2 (81.7 vs. 92.4%, p = 0.007). Major neonatal morbidities were comparable for multiples and singletons in the overall cohort. Presence of hemodynamically significant patent ductus arteriosus (HsPDA) requiring treatment (88.9 vs. 72.5%), air leaks (33 vs. 14.6%, p = 0.02), NEC (30 vs. 14.6%, p = 0.04), and composite morbidity (86 vs. 66%, p = 0.031) were significantly higher in multiples in Group 1. A significantly higher incidence of HsPDA (68.1 vs. 52.4%, p = 0.008) was also observed in multiples in Group 2. Multiple pregnancy was not an independent predictor of an adverse outcome on regression analysis (OR: 0.685, 95% confidence interval: 0.629–2.02) even in GA ≤25 weeks. Conclusion Neonatal mortality and morbidity were comparable in our cohort of PT/VLBW singletons and multiple births, but preterm multiple births ≤25 weeks had a higher incidence of neonatal morbidity. Key Points

The physical development of children born with the use of assisted reproductive technologies

2019 ◽  
Vol 65 (3) ◽  
pp. 148-154
Author(s):  
Zinaida S. Zyuzikova ◽  
Natalya N. Volevodz ◽  
Marina V. Shestakova ◽  
Ivan I. Dedov
Keyword(s):  
Body Weight ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Age Groups ◽  
Reproductive Technologies ◽  
Physical Development ◽  
Anthropometric Measurements ◽  
Singleton Pregnancy ◽  
Group 2 ◽  
Group 1

BACKGROUND. Today, about 0.1% of the world’s population is born using assisted reproductive technology (ART). According to the National Register of ART, in our country these children represent approximately 1.5% of all children born annually. Despite such a high percentage, data on the physical development of children born using ART is contradictory. AIMS. The aim of the study is to compare the clinical and anthropometric measurements of children born with the help of ART with those of children conceived naturally, in different age groups. MATERIAL AND METHODS. The study included 88 children born as the result of the use of ART (Group 1) and 117 children conceived naturally (Group 2). Statistical indicators were evaluated from birth to the onset of puberty. Anthropometric measurements for both groups were analyzed, factoring for multiple pregnancy: length/height, SDS length/height, body weight, SDS body weight, body mass index (BMI), and SDS BMI, at birth and at the times of examination of each child. The levels of insulin-like growth factor-1 (SDS IGF-1) in children of both groups were also determined. RESULTS. SDS length and SDS weight at birth in children born to a singleton pregnancy were 0.82 [0.1; 1.83] and 0.17 [–0.53; 0.9] in Group 1, and 0.5 [–0.35; 1.75] and –0.11 [–0.94; 0.635] in Group 2 (p = 0.62 and 0.37, respectively). In children less than 1 year of age, 1 year to 3 years, and 3 to 11 years, there was no difference of SDS length/height and SDS BMI (p = 0.3 and 0.9; p=0.29 and 0.29; p=0.85 and 0.6, respectively). CONCLUSION. Children born from a singleton pregnancy in both groups were comparable in terms of anthropometric measurements both at birth (adjusted for gestational age), and at different ages. The levels of IGF-1 in children born as a result of the use of ART did not differ from those in children conceived naturally.

scholarly journals Pregnancy Outcomes Following the First Frozen Blastocyst Transfer Among Women Aged Less Than 35 Years Old: A Retrospective Cohort Study

2021 ◽  
pp. 1-7
Author(s):  
Le Hoang ◽  
Le Duc Thang ◽  
Nguyen Thi Lien Huong ◽  
Nguyen Minh Thuy ◽  
Vu Thi Mai Anh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnancy Rate ◽  
Live Birth ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Group 2 ◽  
Group 1

Background: Many guidelines have been issued regarding the number of embryos to be transferred after in vitro fertilization (IVF), but patients and clinicians may be reluctant to accept or offer a single embryo transfer due to the expected lower chance of pregnancy or live birth. This study was aimed to provide additional information on cycle outcome according to the number and quality of thawed transferred blastocysts. Methods:A retrospective cohort study was designed to collect the data of 505 patients who performed the first frozen blastocysts transfer at Tam Anh General Hospital from June 2018 to September 2019. One good-quality embryo was transferred for 121 patients (Group 1), two good for 214 patients (Group 2), one good and one poor for 112 patients (Group 3), one good and two poor for 25 patients (Group 4), and one or two poor for 33 patients (Group 5). Results:The pregnancy rate was 71.9%, 74.8%, 69.4%, 84.0%, and 39.4% in Group 1–5, respectively. The multiple pregnancy rate was 36.9%, 16.9%, and 32.0% in Groups 2–4, respectively, higher than Group 1 (4.9%). The live birth rate was 55.6%, 50.9%, and 60.0% in Group 2–4, respectively, but not significantly different from the Group 1 (47.9%). Conclusions:Transferring an additional good or poor embryo, along with a good embryo, does not increase the live birth rate while the incidence of multiple pregnancies rises significantly.

Relationship between interatrial communication, ductus arteriosus, and pulmonary flow patterns in fetuses with transposition of the great arteries: prediction of neonatal desaturation

2017 ◽  
Vol 27 (7) ◽  
pp. 1280-1288 ◽  
Author(s):  
Laurence Vaujois ◽  
Isabelle Boucoiran ◽  
Christophe Preuss ◽  
Myriam Brassard ◽  
Christine Houde ◽  
...  
Keyword(s):  
Ductus Arteriosus ◽  
Rank Correlation ◽  
Left Ventricular ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Interatrial Communication ◽  
Diastolic Flow ◽  
Pulmonary Flow ◽  
Group 2 ◽  
Group 1

AbstractBackgroundThe relationship between interatrial communication, ductus arteriosus, and pulmonary flow in transposition of the great arteries and intact ventricular septum may help predict postnatal desaturation.MethodsEchocardiographic data of 45 fetuses with transposition of the great arteries and intact ventricular septum and 50 age-matched controls were retrospectively reviewed. Interatrial communication, left and right ventricular output, flow in the ductus arteriosus, as well as effective pulmonary flow were measured. Patients were divided into two groups on the basis of postnatal saturations: group 1 had saturations ⩽50% and group 2 >50%.ResultsOf 45 fetuses, 13 (26.7%) were classified into group 1. Compared with fetuses in group 2, they had a smaller interatrial communication (2.9 versus 4.0 mm, p=0.004) and more retrograde diastolic flow in the ductus arteriosus (92 versus 23%, p=0.002). Both groups showed a significant decrease in ductal flow compared with controls. Patients in group 2 had a higher effective pulmonary flow compared with controls. There was a mild correlation between left ventricular output and size of the interatrial communication (Spearman’s rank correlation 0.44).ConclusionA retrograde diastolic flow is present in most of the fetuses with postnatal desaturation. Fetuses with transposition of the great arteries have a lower flow through the ductus arteriosus compared with controls. Fetuses without restrictive foramen ovale have higher effective pulmonary flow. Peripheral pulmonary vasodilatation due to higher oxygen saturation in pulmonary arteries in the case of transposition of the great arteries could be one possible cause.

scholarly journals The Feasibility of Blood Pressure Control with Autonomic-Assisted Hypertension Therapy Versus JNC 8 Therapy

2020 ◽  
pp. 1-5
Author(s):  
Gary L Murray ◽  
Joseph Colombo
Keyword(s):  
Blood Pressure ◽  
Pressure Control ◽  
Acid Group ◽  
Home Blood Pressure ◽  
Prescription Medications ◽  
Mortality And Morbidity ◽  
Hypertension Therapy ◽  
Group 2 ◽  
Assisted Management ◽  
Group 1

Background: Over one billion people have Hypertension (HTN); mortality and morbidity are increasing. The Parasympathetic and Sympathetic (P&S) nervous systems prominently affect the onset and progression of HTN, yet P&S measures are not used to assist in management. Our objective was to determine the feasibility of HTN control using P&S-guided to JNC 8 HTN therapy. Methods: 46 uncontrolled HTN patients were randomized prospectively to P&S-assisted management, adjusting JNC 8 therapy using the ANX 3.0 Autonomic Monitor and adding (r) Alpha Lipoic Acid (Group 1) vs. JNC 8 (Group 2). Results: The two Groups were similar in: 1) age (mean 66 vs. 70 y/o for Groups 1 and 2, respectively; 2) initial resting home Blood Pressure (BP, Group 1 mean=162/90 mmHg vs. Group 2 mean=166/87 mmHg, 3) initial resting office BP Group 1 mean=151/75 mmHg vs. Group 2 mean=155/73 mmHg, and 4) ethnicity. Upon follow-up (mean=8.35 mo.): 1) mean resting home BPs were 145/77 mmHg (Group 1, 74% of patients at JNC 8 goal) vs. 155/83.5 mmHg (Group 2, 30.4% at JNC 8 goal), and 2) mean resting office BPs were 138/71 mmHg (Group 1) vs. 146/65 mmHg (Group 2). At the studys conclusion, Group 1 Sympathetic tone was lower than that for Group 2 both at rest and upon standing, and Group 1 Parasympathetic tone was higher than that for Group 2 both at rest and upon standing. Conclusion: P&S-assisted HTN therapy is feasible, resulting in improved BP control, through healthier P&S tone on fewer prescription medications.

scholarly journals MORPHOLOGICAL RESEARCH OF PLACENTA IN WOMEN WITH PRETERM LABOR

2019 ◽  
pp. 58-61
Author(s):  
V. O. Sitnikova ◽  
О. M. Nadvorna ◽  
О. V. Kashiyan
Keyword(s):  
Preterm Labor ◽  
Age Groups ◽  
Reproductive Technologies ◽  
Modern Medicine ◽  
Younger Women ◽  
Group 2 ◽  
The City ◽  
Morphological Research ◽  
Angular Transformation ◽  
Group 1

Preterm labor is one of the most current problems of modern medicine. Preterm labor is defined as the birth of a child in the gestation period less than 37 full weeks of gestation and is the second most common cause (after congenital anomalies) of neonatal mortality [3]. The highest percentage of morbidity and mortality occurs in children born to gestational age less than 32 weeks, although the proportion of these newborns is 16 % of all preterm infants [4]. Preterm labor is a polyetiology problem that depends on many factors. One of the major problems is the formation of placental dysfunction, which manifests itself by morphofunctional changes in the placenta associated with violation of uterine-placental circulation. The aim of the study – to obtain the peculiarities of placentas’ histological condition in women with burdent anamnesis and preterm labor with different Apgar point scale of newborn. Materials and Methods. A total of 19 placentas of women with preterm labor were observed in Maternal Hospital No. 5 of Odesa, Ukraine. We studed their residence areas, obstetrical and gynacology anamnesis, current pregnancy and labor anamnesis. We exa­mined the ultrasound datas of the newborns, studied their anthropometric, Apgar scale and histology of placentas’ datas. All interviewed women were devided into two groups: less than 35 years old – 12 women of the group 1 and more than 35 years old – 7 women, it was the group 2. The average age of the examined groups was 31.3 years old. Statistical datas processing was carried out by using the Fisher angular transformation. The degree of probability (P) between two comparative values was considered to be statistically valid when P<0.05. The research results showed that all elder women were married, lived in ecoregions of the city, had more often revolved to artificial reproductive technologies, had singleton gestation compared to younger group of patients. Newborns of women afer 35 had better points of Apgar scale and no one had IUGR compared to newborns of the younger women. Signs of placenta dysfynction were detected in placentas of both groups of women. Conclusions. In our investigation the women of different age groups with preterm labor had signs of placenta dysfunction but women after 35 years had better datas of newborn babies according to Apgar scale and absence of IUGR. Probably, it is connected with residency, official marriage and better preconceptional preparation in this group.

Primary or secondary Bentall-De Bono procedure: are the outcomes worse?

2019 ◽  
Vol 27 (4) ◽  
pp. 271-277
Author(s):  
Ameya Kaskar ◽  
Deepak V Bohra ◽  
Rahul Rao K ◽  
Varun Shetty ◽  
Devi Shetty
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Median Sternotomy ◽  
Postoperative Mortality ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Background The aim of this study was to compare the outcomes of a primary and secondary Bentall-De Bono procedure. Methods From 2008 to 2015 (8-year period), 308 patients underwent a Bentall-De Bono procedure in our institute. The mean age was 43 ± 13 years and 80% were men. Twenty-eight patients had prior cardiac surgery through a median sternotomy (group 1) and 280 underwent a primary Bentall-De Bono procedure (group 2). Various preoperative and perioperative parameters were analyzed before and after propensity-score matching. Results Before propensity-score matching, patients undergoing a secondary Bentall-De Bono procedure had a worse preoperative profile, as indicated by a higher EuroSCORE II ( p < 0.0001), with hospital mortality in group 1 of 14% (4/28) and 5% (14/280) in group 2 ( p = 0.069). After propensity-score matching, there was no significant difference in EuroSCORE II ( p = 0.922) or hospital mortality ( p = 0.729). After adjusting for the different variables, repeat sternotomy could not be identified as an independent predictor of postoperative mortality or morbidity. Survival at the end of 1 and 5 years in both groups showed no significant differences before or after propensity-score matching ( p = 0.328 and p = 0.356, respectively). In Cox multivariable regression analysis, reoperation was not identified as an independent factor for survival before ( p = 0.559) or after propensity-score matching ( p = 0.365). Conclusion A secondary Bentall-De Bono procedure can be performed with acceptable mortality and morbidity, and with midterm survival rates comparable to those of a primary Bentall-De Bono procedure.

A beneficial technique for preventing the device protrusion to the aorta during percutaneous patent ductus arteriosus closure: “Balloon-assisted device releasing technique”

2019 ◽  
Vol 29 (11) ◽  
pp. 1380-1386 ◽  
Author(s):  
Serdar Epçaçan ◽  
Mustafa Orhan Bulut ◽  
İlker Kemal Yücel ◽  
Ahmet Çelebi
Keyword(s):  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Safe Procedure ◽  
Disc Protrusion ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Patent Ductus Arteriosus Closure ◽  
Group 2 ◽  
Patent Ductus ◽  
Group 1

AbstractBackground:Although percutaneous closure of patent ductus arteriosus is an established safe procedure, protrusion of the device to descending aorta may occur in various degrees during these procedures, especially in small infants. The aim of our study is to evaluate the benefits of balloon-assisted device releasing technique in the era of preventing device protrusion and conditions related to protrusion.Methods:One hundred and fifty-five infants, who underwent patent ductus arteriosus closure with Amplatzer duct occluder I device between January, 2012 and December, 2018, were retrospectively analysed. Balloon-assisted device releasing technique was used in 20 cases (group 1, 12.9%), between January, 2015 and December, 2018. Procedures in which the technique had been used were compared with the remaining ones (group 2, 87.1%, n = 135) with regard to device stabilisation, aortic disc protrusion to the aorta, iatrogenic coarctation, and device embolisation.Results:There was no significant difference by means of gender, age, weight, and the ductal diameter, whereas the average mean pulmonary artery pressure was significantly higher in group 1. Device protrusion and related complications were significantly higher in group 2; thus, additional catheterisations or surgical interventions were required, while no additional intervention was required in group 1.Conclusion:The balloon-assisted device releasing technique provides a good device stabilisation and prevents protrusion of the device and related complications during percutaneous patent ductus arteriosus closure in selected cases.

97 PRELIMINARY DESCRIPTIVE STUDY OF EQUINE PLACENTA GENERATED AFTER TRANSFER OF IN VIVO- AND IN VITRO-PRODUCED EMBRYOS

2017 ◽  
Vol 29 (1) ◽  
pp. 156 ◽  
Author(s):  
A. Lanci ◽  
J. Mariella ◽  
B. Merlo ◽  
C. Castagnetti ◽  
E. Iacono
Keyword(s):  
Embryo Transfer ◽  
Intracytoplasmic Sperm Injection ◽  
Reproductive Technologies ◽  
Control Group ◽  
Placental Development ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Placental changes associated with artificial reproductive technologies have been described in several species, but little information is available in horses. Joy et al. (2012) reported that human placentas from intracytoplasmic sperm injection derived embryos were heavier and thicker than those produced after natural conception. Despite the most growing interest and efficiency of artificial reproductive technologies in equine species, only recently, Pozor et al. (2016) described placental abnormalities in pregnancies generated by somatic cell NT, but there are no studies on equine placenta generated by intracytoplasmic sperm injection and traditional embryo transfer. In the present preliminary study, macroscopic differences of placentas generated after transfer of in vitro- or in vivo-produced embryos were registered. Twelve Standardbred recipient mares with pregnancy generated after transfer of in vivo-derived (Group 1) and in vitro-derived (Group 2) embryos were enrolled; 10 Standardbred mares with pregnancy derived by traditional AI were included as control (Group 3). All pregnancies were physiological, and newborn foals were healthy. Mare age, parity, length of pregnancy, gross evaluation and weight of placenta, total length of umbilical cord (UC), length of UC, number of UC coils, foal sex, and weight at birth were registered. Collected data are listed in Table 1 and are expressed as mean ± standard deviation. Differences between groups were evaluated by 1-way ANOVA, and the difference in proportion of overweight placentas was evaluated with the Fisher test. The gross evaluation of placenta revealed 8/12 placentas (2/4 Group 1; 6/8 Group 2) were heavier than 11% (Madigan, 1997) due to oedema of the chorioallantois. No overweight placentas were registered in Group 3. In Group 1, 1/4 placentas had villous hypoplasia, and in Group 2, 1/8 placentas had cystic pouches on the UC. There were no significant differences among groups. However, the proportion of overweight placentas between Group 2 (6/8) and Group 3 (0/10) approached significance (P = 0.06). Although preliminary, the results of the present study suggest that production of equine embryos in vitro may lead to alterations in placental development. Several studies in cattle and sheep have suggested that alterations in the placentas of pregnancies derived from in vitro-produced embryos are related to effects of culture on epigenetic regulation. Less is known in the horse about the effects of in vitro embryo production on placental development; thus, further research in this area is necessary. Table 1. Characteristics of full-term placentas derived from AI or embryo transfer with in vivo- and in vitro-produced embryos

Effectiveness of programs of auxiliary reproductive technologies in patients of late reproductive age

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (1) ◽  
pp. 109-112 ◽  
Author(s):  
E P Beik ◽  
A G Syrkasheva ◽  
N V Dolgushina
Keyword(s):  
Live Birth ◽  
Assisted Reproductive Technologies ◽  
Laboratory Data ◽  
Age Groups ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Art Programs ◽  
Group 2 ◽  
Twofold Decrease ◽  
Group 1

The aim of the study was to study the effectiveness of assisted reproductive technologies (ART) programs in patients of different age groups, taking into account clinical and laboratory data. Materials and methods. A prospective cohort study included 188 patients with infertility of various genesis who were stratified according to age: group 1 (n=87) - patients of late reproductive age - LRA (>35 years), group 2 (n=101) - patients of early reproductive age (≤35 years). Results. In patients with ART compared with patients with LRA, the chances of pregnancy were reduced by 2.2 times (odds ratio - OR 2.2, 95% confidence interval - CI 1.1-4.3), the chances of live birth were 2 times (OR 2.0; 95% CI 1.0-3.9). The only factor affecting the onset of pregnancy in addition to age was the number of embryos received. The threshold age at which and above which the chances of pregnancy and live birth decreased as much as possible were the age of 37 years: the OR of pregnancy 2.6 (95% CI 1.4-5.1, AUC 61.3%), OR live birth 2.6 (95% CI 1.3-5.1, AUC 60.8%). Conclusions. In patients of LRA there is a twofold decrease in the effectiveness of ART programs due to a significant decrease in the number of oocytes obtained, mature oocytes, and, accordingly, embryos.

Outcome of art programs for patients with habitable inequality of pregnancy in anamnesis

GYNECOLOGY ◽  
2017 ◽  
Vol 19 (6) ◽  
pp. 43-45
Author(s):  
O E Korotchenko ◽  
A D Gvozdeva ◽  
A G Syrkasheva
Keyword(s):  
Live Birth ◽  
Pregnancy Loss ◽  
Reproductive Technologies ◽  
Clinical Pregnancy ◽  
Art Programs ◽  
Excellent Quality ◽  
Comparison Groups ◽  
History Of ◽  
Group 2 ◽  
Group 1

The aim of the study was to assess the effectiveness of auxiliary reproductive technologies (ART) programs in patients with a habitual miscarriage (HM) in an anamnesis. Materials and methods. A prospective cohort study included 200 patients with infertility, 100 of whom had a history of HM (2 or more pregnancy loss before 22 weeks of gestation) - group 1, and 100 patients had tubular peritoneal infertility without loss of pregnancy in the history (group 2 ). Results. Patients with ART programs with a history of HM are characterized by a higher age and, as a consequence, a lower level of AMH, a greater BMI, a higher level of androgens, and poorer embryological indicators (fewer mature oocytes, more oocytes with dysmorphisms, and fewer blastocysts of excellent quality). The frequency of biochemical and clinical pregnancy did not differ in comparison groups. The frequency of spontaneous abortions was observed in 12% in group 1 and in 3% in group 2 (p=0.0156). The incidence of live birth was 17% in group 1 and 24% in group 2 (p=0.2201). Conclusions. The effectiveness of ART programs is lower in patients with habitual miscarriage: the odds of live birth are 1.4 times lower due to the obtaining of a smaller number of blastocysts of excellent quality, and the chances of spontaneous miscarriage are 4.4 times higher than in patients without loss of pregnancy in the anamnesis.

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