Twin Pregnancies Complicated by a Single Malformed Fetus: Chorionicity, Outcome and Management

2010 ◽  
Vol 13 (5) ◽  
pp. 501-507 ◽  
Author(s):  
Ali Gedikbasi ◽  
Alpaslan Akyol ◽  
Gokhan Yildirim ◽  
Ali Ekiz ◽  
Ahmet Gul ◽  
...  
Keyword(s):  
Gestational Age ◽  
Statistical Significance ◽  
Expectant Management ◽  
Control Group ◽  
Study Group ◽  
Preliminary Evaluation ◽  
Gestational Age At Birth ◽  
The Impact ◽  
Twin Pregnancies ◽  
Age At Birth

The objective of this study was to evaluate the impact of one abnormal fetus in a twin pregnancy, to compare impact of chorionicity and clinical outcome of intervention and expectant management. Thirty-seven dichorionic (DC) twins and 18 monochorionic (MC) twins complicated with one malformed fetus were evaluated for gestational age, birthweight and perinatal outcome. Six hundred and forty-two twin pregnancies were evaluated in the database. The control groups consisted of 429 DC and 86 MC twins without anomalous fetus. Mean birthweight and gestational age at birth for DC control group were (n= 429; 2137g and 34.71 weeks), DC study group,n= 37; 2117g (p= .338) and 33.97 weeks (p= .311), and DC study group with major malformations,n= 30; 2019g (p= .289) and 33.3 weeks (p= .01), and showed only significance for gestational age. There was no statistical significance between MC control group,n= 86; 2097g and 34.93 weeks, and MC study group,n= 18; 2237g (p= .338), and 34.42 weeks (p= .502). Because of limited data, the preliminary evaluation for expectant management and intervention, and survival of at least one normal fetus showed no impact. We conclude that, although, all DC twin pregnancies have a risk for preterm delivery, DC twins complicated with major malformation of one twin, have a lower mean gestational age at birth. Preliminary results for intervention does not improve fetal outcome for DC and MC twins and needs further evaluation with greater studies of impact or review.

scholarly journals Birth-weight centiles and the risk of serious adverse neonatal outcomes at term

2018 ◽  
Vol 46 (9) ◽  
pp. 1048-1056 ◽  
Author(s):  
Joanna Yu ◽  
Christopher Flatley ◽  
Ristan M. Greer ◽  
Sailesh Kumar
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Predicted Probability ◽  
Exposure Variable ◽  
Adverse Neonatal Outcomes ◽  
Gestational Age At Birth ◽  
The Impact ◽  
Age At Birth

Abstract Background: Birth-weight is an important determinant of perinatal outcome with low birth-weight being a particular risk factor for adverse consequences. Aim: To investigate the impact of neonatal sex, mode of birth and gestational age at birth according to birth-weight centile on serious adverse neonatal outcomes in singleton term pregnancies. Materials and methods: This was a retrospective cohort study of singleton term births at the Mater Mother’s Hospital, Brisbane, Australia. Serious adverse neonatal outcome was defined as a composite of severe acidosis at birth (pH ≤7.0 and/or lactate ≥6 mmol/L and/or base excess ≤−12 mmol/L), Apgar <3 at 5 min, neonatal intensive-care unit admission and antepartum or neonatal death. The main exposure variable was birth-weight centile. Results: Of the 69,210 babies in our study, the overall proportion of serious adverse neonatal outcomes was 9.1% (6327/69,210). Overall, neonates in the <3rd birth-weight centile category had the highest adjusted odds ratio (OR) for serious adverse neonatal outcomes [OR 3.53, 95% confidence interval (CI) 3.06–4.07], whilst those in the ≥97th centile group also had elevated odds (OR 1.51, 95% CI 1.30–1.75). Regardless of birth modality, smaller babies in the <3rd centile group had the highest adjusted OR and predicted probability for serious adverse neonatal outcomes. When stratified by sex, male babies consistently demonstrated a higher predicted probability of serious adverse neonatal outcomes across all birth-weight centiles. The adjusted odds, when stratified by gestational age at birth, were the highest from 37+0 to 38+6 weeks in the <3rd centile group (OR 5.97, 95% CI 4.60–7.75). Conclusions: Low and high birth-weights are risk factors for serious adverse neonatal outcomes. The adjusted OR appears to be greatest for babies in the <3rd birth-weight centile group, although an elevated risk was also found in babies within the ≥97th centile category.

scholarly journals Effects of gestational age at birth on perinatal structural brain development in healthy term-born babies

2021 ◽  
Author(s):  
Oliver Gale-Grant ◽  
Sunniva Fenn-Moltu ◽  
Lucas Franca ◽  
Ralica Dimitrova ◽  
Daan Christiaens ◽  
...  
Keyword(s):  
Linear Regression ◽  
Gestational Age ◽  
Neurodevelopmental Outcome ◽  
Magnetic Resonance Images ◽  
Linear Regression Models ◽  
Early Term ◽  
Gestational Age At Birth ◽  
The Impact ◽  
Age At Birth ◽  
Structural Brain

Multiple studies have demonstrated less favourable childhood outcomes in infants born in early term (37-38 weeks gestation) compared to those born at full term (40-41 weeks gestation). While this could be due to lower birthweight and greater perinatal morbidity, gestational age at birth may also have a direct effect on the brain and subsequent neurodevelopment in term-born babies. Here we characterise structural brain correlates of gestational age at birth in healthy term-born neonates and their relationship to later neurodevelopmental outcome. We used T2 and diffusion weighted Magnetic Resonance Images acquired in the neonatal period from a cohort (n=454) of healthy babies born at term age (>37 weeks gestation) and scanned between 1 and 41 days after birth. Images were analysed using tensor based morphometry (TBM) and tract based spatial statistics (TBSS). Neurodevelopment was subsequently assessed at age 18 months using the Bayley-III Scales of Infant and Toddler Development (n=281), and the effects of gestational age at birth and related neuroimaging findings on outcome were analysed with linear regression. Infants born earlier had areas of higher relative ventricular volume, and lower relative brain volume in the basal ganglia, cerebellum and brainstem. Earlier birth was also associated with lower fractional anisotropy, higher mean, axial and radial diffusivity in major white matter tracts. Gestational age at birth was positively associated with all Bayley-III subscales at age 18 months. Linear regression models predicting outcome from gestational age at birth were significantly improved by adding neuroimaging features associated with gestational age at birth. This work adds to the growing body of evidence of the impact of early term birth and highlights the importance of considering the effect of gestational age at birth in future neuroimaging studies including term-born babies.

Short-Term Postnatal Renal Function in Twin Anemia-Polycythemia Sequence

2015 ◽  
Vol 39 (3) ◽  
pp. 192-197 ◽  
Author(s):  
Lianne Verbeek ◽  
Femke Slaghekke ◽  
Romain Favre ◽  
Marine Vieujoz ◽  
Francesco Cavigioli ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Gestational Age ◽  
Twin Pair ◽  
Control Group ◽  
Short Term ◽  
Monochorionic Twins ◽  
Gestational Age At Birth ◽  
Age At Birth

Objective: To evaluate the short-term renal function in neonates with twin anemia-polycythemia sequence (TAPS). Methods: All consecutive monochorionic twins with TAPS with double survivors admitted to three European centers were included in this retrospective study. Each twin pair was matched for gestational age at birth with a control twin pair unaffected by TAPS or twin-twin transfusion syndrome. Creatinine and urea levels in the first week after birth were recorded. Short-term postnatal renal dysfunction was defined as creatinine >100 μmol/l during the first week after birth. Results: A total of 52 TAPS twin pairs and 52 control twin pairs with a median gestational age of 31 weeks at birth were included in the study. In the TAPS group, donors had higher mean creatinine levels compared to recipients, 85 versus 71 μmol/l, respectively (p = 0.001). Short-term renal dysfunction was detected in 26.0% (13/50) of the donors versus 6.3% (3/48) of the recipients (p = 0.022). In the control group, no inter-twin differences in creatinine levels were found. Conclusions: Donor twins with TAPS have higher creatinine levels than recipient twins, suggesting that chronic inter-twin transfusion in TAPS may also cause short-term renal dysfunction. Long-term renal consequences in TAPS donors require further investigation.

scholarly journals Anthropometric Assessment after Slow Breathing Exercise in Type 2 Diabetic Male Patients

2020 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Statistical Significance ◽  
Control Group ◽  
Study Group ◽  
Physical And Mental Health ◽  
Anthropometric Parameters ◽  
Breathing Exercise ◽  
Male Patients ◽  
Slow Breathing ◽  
The Impact

Background: Yoga based slow breathing exercise (SBE) has several beneficial effects on physical and mental health. Objectives: To observe the impact of slow breathing exercise on anthropometric parameters in male patients with type 2 diabetes mellitus (T2DM). Methods: This prospective interventional study was conducted on sixty (60) male diagnosed T2DM patients aged 45-55 years with duration of disease 5-10 years enrolled from Out Patients Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, and Dhaka. By simple random technique the subjects were divided into control group (n=30) and study group (n=30). Yoga based slow breathing exercise was practiced by the study group for 30 minutes twice daily for 3 months. Height, weight, body mass index (BMI), waist circumference, hip circumference and waist/hip ratio were assessed at the start of the study and after 3 months. Independent sample and paired t-test were used for statistical analysis and p<0.05was considered as statistical significance. Results: In this study the value of mean BMI was significantly (p=<0.05) reduced after 3 months of SBE. Again, all the anthropometric parameters were significantly (p=>0.05) increased after 3 months in the group who did not undergo SBE. Conclusion: Anthropometric parameters were improved after slow breathing exercise for 3 months.

9 The Burden of Bronchopulmonary Dysplasia and Pulmonary Vascular Disease in Premature Infants

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e7-e7
Author(s):  
Gabriela de Carvalho Nunes ◽  
Punnanee Wutthigate ◽  
Jessica Simoneau ◽  
Claudia Renaud ◽  
Adrian Dancea ◽  
...  
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Gestational Age ◽  
Ductus Arteriosus ◽  
Positive Pressure ◽  
Pulmonary Vascular Disease ◽  
Intervention Policy ◽  
Gestational Age At Birth ◽  
The Impact ◽  
Age At Birth

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Extremely premature infants are at a high risk of bronchopulmonary dysplasia (BPD) and BPD-associated pulmonary hypertension (PH). Prolonged patency of the ductus arteriosus (PDA) may worsen PH; however, due to the lack of evidence supporting improvement in outcomes after strategies to promote ductal closure, our center has adopted a strict non-intervention policy since 2013. Objectives Assess PH prevalence and severity, as well as the impact of BPD on echocardiographic parameters of cardiac performance. Design/Methods Retrospective cohort of infants &lt;29 weeks gestational age at birth, admitted between 2015 and 2019, and without genetic/congenital anomalies. Measurements from the echocardiography acquired closest to 36 weeks were done by masked experts. Severe BPD was defined as positive pressure support at 36 weeks. PH was defined as an estimated systolic pulmonary pressure (SPAP) ≥40 mmHg or an abnormal septal curvature by eccentricity index (EI) (&gt;1.3). Results Out of 387 infants, 222 were included, of which 27 (12%) were categorized as severe BPD and 78 (35%) had PH. Severe BPD was associated with lower birth weight (704±214 vs 842±229g, p&lt;0.01), longer hospitalization (median 138 [IQR 108-167] vs 103 [IQR 86-125] days, p&lt;0.01) and longer mechanical ventilation duration (median 82 [IQR 33-107] vs 17 [IQR 2-32] days, p&lt;0.01), with no difference in gestational age at birth. Severe BPD was associated with PH (70% vs 43%, p&lt;0.01). The combined outcome of death (after the 36 weeks echocardiography) or severe BPD was associated with PH (68% vs 30%, p&lt;0.01), smaller left ventricle length in diastole (2.8±0.5 vs 3.0±0.5 cm, p=0.03), decrease in the tricuspid annular plane systolic excursion (0.7±0.2 vs 0.9±0.2 cm, p&lt;0.01), abnormal EI (1.31±0.25 vs 1.17±0.18, p&lt;0.01) and smaller right ventricle fraction area change (41.3±5.8 vs 47.8±7.6%, p&lt;0.01), without a significant increase on SPAP (35±21 vs 35±14, p=0.15). Other echocardiographic markers were similar. Conclusion In the context of a PDA non-intervention policy, a third of our population was affected by PH at 36 weeks. Furthermore, those with severe BPD or death had signs of RV dysfunction (despite similar SPAP estimate), indicating that the effect of BPD on pulmonary vascular remodelling and cardiac function may be underestimated.

scholarly journals The Impact of Symptoms of Depression and Walking on Gestational Age at Birth in African American Women

2017 ◽  
Vol 27 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Carmen Giurgescu ◽  
Jaime C. Slaughter-Acey ◽  
Thomas N. Templin ◽  
Dawn P. Misra
Keyword(s):  
African American ◽  
African American Women ◽  
Gestational Age ◽  
American Women ◽  
Symptoms Of Depression ◽  
Gestational Age At Birth ◽  
The Impact ◽  
Age At Birth

scholarly journals Impact of a Stay-at-Home Order on Stroke Admission, Subtype, and Metrics during the COVID-19 Pandemic

2020 ◽  
Vol 10 (3) ◽  
pp. 159-165
Author(s):  
Fnu Rameez ◽  
Philip McCarthy ◽  
Yao Cheng ◽  
Laurel M. Packard ◽  
Alan T. Davis ◽  
...  
Keyword(s):  
Hemorrhagic Stroke ◽  
Statistical Significance ◽  
Control Group ◽  
Study Group ◽  
Care Hospital ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Number Of Patients ◽  
The Impact ◽  
At Home

<b><i>Objective:</i></b> Our study aims to evaluate the impact of a stay-at-home order on stroke metrics during the 2019-novel coronavirus (COVID-19) pandemic. <b><i>Methods:</i></b> Data on baseline characteristics, stroke subtype, initial National Institutes of Health Stroke Scale (NIHSS) score, the time between last known well (LKW) to emergency department (ED) arrival, tissue plasminogen activator (tPA) administration, the involvement of large vessel occlusion (LVO), and whether mechanical thrombectomy (MT) was pursued in patients with acute stroke were extracted from 24 March to 23 April 2020 (the time period of a stay-at-home order was placed due to the COVID-19 pandemic as the study group) at a tertiary care hospital in West Michigan, USA, compared with data from 24 March to 23 April 2019 (control group). <b><i>Results:</i></b> Our study demonstrated a reduction in cases of acute ischemic stroke (AIS), although this did not reach statistical significance. However, there was an increase in hemorrhagic stroke (7.5% controls vs. 19.2% study group). The age of stroke patients was significantly younger during the period of the stay-at-home order compared to the control group. We identified a significant overall delay of ED arrivals from LKW in the study group. Additionally, an increased number of AIS patients with LVO in the study group (34.8%) was found compared to the control group (17.5%). A significantly increased number of patients received MT in the study group. Additionally, 11 patients were COVID-19 PCR-positive in the study group, 10 with AIS and only 1 with hemorrhagic stroke. Patients with COVID-19 had a high incidence of atrial fibrillation and hyperlipidemia. One AIS patient with COVID-19 rapidly developed cytotoxic edema with corresponding elevated inflammatory biomarkers. No statistical significance was noted when stroke subtype, LVO, and MT groups were compared. <b><i>Conclusions:</i></b> There was a trend of decreasing AIS admissions during the COVID-19 pandemic. There was also a significantly increased number of AIS patients with LVO who received MT, especially those with COVID-19. We conclude that cytokine storm resulting from SARS-CoV-2 infection might play a role in AIS patients with COVID-19.

scholarly journals Outcome of expectantly managed small-for-gestational-age pregnancies with normal Doppler parameters- a prospective cohort study

2021 ◽  
Vol 10 (3) ◽  
pp. 1134
Author(s):  
Sneha Mishra ◽  
Krishna Agarwal
Keyword(s):  
Birth Weight ◽  
Caesarean Section ◽  
Gestational Age ◽  
Expectant Management ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Biophysical Profile ◽  
Group 3 ◽  
The Mean

Background: SGA foetuses with normal Dopplers are not at risk of IUD. However, there is lack of consensus about timing of delivery of SGA foetuses. Clinicians commonly induce all SGA pregnancies at 37 weeks. Expectant management of SGA foetuses beyond 37 weeks is not well studied.Methods: We followed up women with clinically suspected growth restriction with foetal biometry, Doppler and biophysical profile. Pregnancies with foetal AC between 10th to 3rd centile with normal Dopplers were recruited in the study group. The women were allowed to go in spontaneous labor till 39+6/7 weeks or were induced at 39+6/7 weeks. The outcome of such cases was compared with controls who were induced at 37+0/7 weeks.Results: Spontaneous labor occurred in 42% subjects in study group whereas in control group all were induced. Mean gestation at delivery in the study group was increased (39.57±0.71 versus 37.0±0.0, p value <0.001). Almost 81% of the subjects in study group delivered after 39 weeks. The rate of caesarean section was significantly lower in study group (3% versus 22%, p value-0.024). Also, the risk of intrapartum foetal distress was lower in study group (3/36 versus 1/36).The mean birth weight in the study group was higher (2426.5±154.1 gm versus 2297.9±101.4 gm, p value <0.001.Conclusions: Expectant management of SGA pregnancies with normal Doppler parameters leads to a significant increase in gestational age at birth and the mean birth weight and a significant reduction in caesarean section rate. 

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