Twin pregnancy in women above the age of 45 years: maternal and neonatal outcomes

2017 ◽  
Vol 45 (7) ◽  
Author(s):  
Tomer Avnon ◽  
Alon Haham ◽  
Ariel Many
Keyword(s):  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Admission Rate ◽  
Neonatal Outcomes ◽  
Study Group ◽  
Perinatal Complications ◽  
Childbearing Age ◽  
Younger Women ◽  
Maternal And Neonatal Outcomes ◽  
Twin Pregnancies

AbstractChildbearing age continues to rise and, with the increasing implementation of assisted reproductive technology (ART), the number of multiple pregnancies has also risen. This is a retrospective cohort study on maternal and neonatal outcomes of the twin pregnancies of 57 women aged ≥45 years compared to 114 younger women who gave birth in our institution between January 2011 and August 2015. Data were extracted from the real-time computerized database. The rates of hypertensive complications and pre-eclampsia (PE) were much higher in the study group compared to the controls (24/57 vs. 19/114, P=0.000 and 15/57 vs. 13/114, P=0.013, respectively). The respective incidence of very low birth weight (VLBW) was also significantly higher (14/114 vs. 12/228, P=0.021). Infants in the study group required four times more intubation and had a higher admission rate to the neonatal intensive care unit (NICU) compared to control infants (14/114 vs. 6/228 P=0.000 and 42/114 vs. 57/228, P=0.023, respectively). We conclude that women older than 45 years with twin pregnancies have higher maternal and perinatal complications with worse outcomes in comparison with younger women. When pregnancy is attempted via ART, embryo transfer of only one embryo should be considered in this age group.

scholarly journals Effects of the Timing of Labour Induction on Maternal and Neonatal Outcomes in Low-risk Nulliparous Chinese Women

2020 ◽  
Author(s):  
Qiang WEI ◽  
Qin-yan CAO ◽  
Li ZHANG ◽  
Yi XU ◽  
Mei-fan DUAN
Keyword(s):  
Neonatal Intensive Care ◽  
Chinese Women ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Labour Induction ◽  
Control Group ◽  
Study Group ◽  
Retrospective Case ◽  
Maternal And Neonatal Outcomes ◽  
Control Study

Abstract Backgroud: When labour induction should be offered to women at or beyond term is unclear. This work aimed to investigate the effects of the timing of labour induction on maternal and neonatal outcomes in low-risk pregnancies. Methods: This retrospective case-control study involved low-risk primigravid pregnant mothers in whom labour was induced at 40-41+6 weeks at our two hospitals between January and December 2017. According to the gestational age at labour induction, participants were categorized into the study group (40-40+6 weeks, n=284) or to the control group (41-41+6 weeks, n=172), and maternal and neonatal outcomes were compared.Results: The study group showed significantly shorter labour in the first stage (391.8±225.7 vs. 472.0±268.9 min, P=0.006), second stage (65.41±38.66 vs. 53.73±31.58 min, P= 0.008) and total stage (453.0±235.8 vs. 535.7±259.8 min, P=0.005). The two groups showed no significant differences in the methods of labour induction or in the rates of failure of labour induction, of caesarean delivery, of postpartum haemorrhage, or of admission to the neonatal intensive care unit.Conclusions: Our retrospective study suggests that inducing labour at 40-40+6 weeks does not increase the risk of adverse maternal or foetal outcomes, and that it shortens labour. These results suggest that labor induction at 40-40+6 weeks was feasible for low-risk primiparas.Trial registration: The research has been approved by the Ethics Committee of West China Second Hospital of Sichuan University and Chengdu Women and Children's Central Hospital, China. Patients gave written informed consent for their anonymized medical data to be analyzed and published for research purposes.

scholarly journals Unattended Home Labor until Complete Cervical Dilatation Ending with Hospital Delivery: Analysis of 238 Pregnancies

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Ozlem Gun Eryilmaz ◽  
Nasuh Utku Dogan ◽  
Cavidan Gulerman ◽  
Leyla Mollamahmutoglu ◽  
Nedim Cicek ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Hospital Setting ◽  
Current Data ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Study Group ◽  
Hospital Delivery ◽  
Active Labor ◽  
Maternal And Neonatal Outcomes ◽  
At Home

Objectives. Hospital fear and avoidance of the routine hospital obstetrical interventions cause some women with low-risk pregnancies to spend most of the active labor period at home, and subsequently they present to the hospital for delivery. Our aim was to analyze the maternal and neonatal outcomes of pregnancies with a planned hospital birth, yet spending the first stage of labor at home without a health provider and completing the delivery in the hospital setting.Methods. We retrospectively compared 238 pregnancies having home labor plus hospital delivery (study group) with 476 pregnancies that had spent the whole labor in the hospital setting, considering various maternal and neonatal outcomes.Results. Cesarean and episiotomy rates were lower (P<0.0001andP<0.001, resp.), but neonatal intensive care unit admissions of the infants were more prevalent (P<0.01) in the study group. Other maternal and neonatal outcomes including neonatal mortality were comparable.Conclusion. Although our preliminary data generally do support the safety of home active labor plus hospital delivery for low-risk pregnancies, the clinical implications of current data warrant further prospective trials.

scholarly journals Maternal and Neonatal Outcomes Associated with Psychostimulant Use in Pregnancy

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ximena Camacho ◽  
Alys Havard ◽  
Helga Zoega ◽  
Margaret Wilson ◽  
Tara Gomes ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Cohort Analysis ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
The Usa ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy

IntroductionRecent evidence from the USA and Nordic countries suggests a possible association between psychostimulant use during gestation and adverse pregnancy and birth outcomes. Objectives and ApproachWe employed a distributed cohort analysis using linked administrative data for women who gave birth in New South Wales (NSW; Australia) and Ontario (Canada), whereby a common protocol was implemented separately in each jurisdiction. The study population comprised women who were hospitalized for a singleton delivery over an 8 (NSW) and 4 (Ontario) year period, respectively, with the NSW cohort restricted to social security beneficiaries. Psychostimulant exposure was defined as at least one dispensing of methylphenidate, amphetamine, dextroamphetamine or lisdexamfetamine during pregnancy. We examined the risk of maternal and neonatal outcomes among psychostimulant exposed mothers compared with unexposed mothers. ResultsThere were 140,356 eligible deliveries in NSW and 449,499 in Ontario during the respective study periods. Fewer than 1% of these pregnancies were exposed to psychostimulants during gestation, although use was higher in Ontario (0.30% vs 0.11% in NSW). Preliminary unadjusted analyses indicated possible associations between psychostimulant use in pregnancy and higher risks of pre-term birth (relative risk [RR] 1.7, 95% confidence interval [CI] 1.4-2.0 (Ontario); RR 1.8, 95% CI 1.2-2.6 (NSW)) and pre-eclampsia (RR 2.0, 95% CI 1.5-2.6 (Ontario); RR 2.0, 95% CI 1.2-3.5 (NSW)). Similarly, psychostimulant use was associated with higher risks of low birthweight (RR 1.6, 95% CI 1.3-1.9 (Ontario); RR 2.0, 95% CI 1.3-3.0 (NSW)) and admission to neonatal intensive care (RR 2.1, 95% CI 1.9-2.3 (Ontario); RR 1.5, 95% CI 1.1-1.9 (NSW)). Conclusion / ImplicationsUnadjusted analyses indicate an increased risk of adverse maternal and birth outcomes associated with psychostimulant exposure during pregnancy, potentially representing a placental effect. We are currently refining the analyses, employing propensity score methods to adjust for confounding.

Nonmedically Indicated Induction of Labor Compared with Expectant Management in Nulliparous Women Aged 35 Years or Older

2018 ◽  
Vol 36 (01) ◽  
pp. 045-052 ◽  
Author(s):  
Katherine Bowers ◽  
Jane Khoury ◽  
Tetsuya Kawakita
Keyword(s):  
Intensive Care Unit ◽  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Expectant Management ◽  
Induction Of Labor ◽  
Neonatal Outcomes ◽  
Nulliparous Women ◽  
Maternal And Neonatal Outcomes ◽  
Nicu Admission

Objective This article compares maternal and neonatal outcomes in women aged ≥ 35 years who experienced nonmedically indicated induction of labor (NMII) versus expectant management. Study Design This was a retrospective cohort study of nulliparas aged ≥ 35 years with a singleton and cephalic presentation who delivered at term. Outcomes were compared between women who underwent NMII at 37, 38, 39, and 40 weeks' gestation and those with expectant management that week. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for predefined covariates. Results Of 3,819 nulliparas aged ≥ 35 years, 1,409 (36.9%) women underwent NMII. Overall at 39 weeks' gestation or later, maternal and neonatal outcomes were similar or improved with NMII. At 37, 38, and 39 weeks' gestation, NMII compared with expectant management was associated with decreased odds of cesarean delivery at 37, 38, and 39 weeks' gestation. At 40 weeks' gestation, NMII compared with expectant management was associated with an increased odds of operative vaginal delivery and a decreased odds of neonatal intensive care unit (NICU) admission. Conclusion In nulliparous women aged ≥ 35 years, NMII was associated with decreased odds of cesarean delivery at 37 to 39 weeks' gestation and decreased odds of NICU admission at 40 weeks' gestation compared with expectant management.

Abstract P179: Neonatal Outcomes in Normal and Preeclamptic Pregnancies: A retrospective Comparative Study

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Niraj Vora ◽  
Ram R Kalagiri ◽  
Venkata N Raju ◽  
Nathan Drever ◽  
Madhava R Beeram ◽  
...  
Keyword(s):  
Birth Weight ◽  
Hospital Stay ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
De Novo ◽  
Length Of Hospital Stay ◽  
Admission Rate ◽  
Retrospective Chart Review ◽  
Neonatal Outcomes ◽  
Retrospective Comparative Study

Background: Preeclampsia (PreE), a de novo development of Hypertension in consort with proteinuria after 20 weeks of gestation is the leading cause of morbidity and mortality in mother and the offspring. It affects approximately 3-8% of overall pregnancies. Although, specific etiologies remain unknown, it has been supported by various studies that PreE is not just a single disorder, but a syndrome of pertinent multiple pathophysiological factors. Methods: An IRB approved retrospective chart review over a year (January 2014 to December 2014) was conducted of all pregnancies occurred at Baylor Scott and White Health System, Temple, Texas (N = 3704). We divided all pregnancies into two separate groups: PreE (N = 299) vs. Non PreE (N = 3405). We compared the neonatal outcomes between two groups including their offspring’s gestational age, birth weight, admission rate to Neonatal Intensive Care Unit (NICU), occurrence of bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), hypoglycemia, thrombocytopenia, intraventricular hemorrhage (IVH) and length of hospital stay (LOS). Results: We found amongst these two groups, infants born to PreE mothers have significantly lower birthweight (Mean = 2807 grams, SD = 841 grams) compared to Non PreE mothers (Mean = 3383 grams, SD = 619 grams) (P<0.05), significantly lower GA (Mean = 36.7 weeks, SD = 3.25 weeks) compared to Non PreE group (Mean = 38.7 weeks, SD = 2.1 weeks) (P<0.05), significantly higher rate of BPD (11%) compared to Non PreE group (6.9%)(P<0.05), significantly higher occurrence of hypoglycemia (26%) compared to non PreE group (20%) (P<0.05), significantly higher rate of thrombocytopenia (28%) compared to Non PreE group (17%) (P<0.05) and significantly higher length of hospital stay (Mean = 19 days, SD = 20 days) compared to Non PreE group (Mean = 14 days, SD = 20 days) (P<0.05). Conclusion: We can conclude from this retrospective analysis that infants born to PreE mothers have lower birth weight indicating the intrauterine growth restriction and the lower gestational age indicating preterm birth. Moreover, the data indicate the higher rate of BPD, hypoglycemia, thrombocytopenia and requirement of increased length of hospital stay in infants born to PreE mothers compared to Non PreE mothers.

Very Low Birth Weight Outcomes of the National Institute of Child Health and Human Development Neonatal Network

PEDIATRICS ◽  
1991 ◽  
Vol 87 (5) ◽  
pp. 587-597 ◽  
Author(s):  
Maureen Hack ◽  
Jeffrey D. Horbar ◽  
Michael H. Malloy ◽  
Linda Wright ◽  
Jon E. Tyson ◽  
...  
Keyword(s):  
Birth Weight ◽  
Child Health ◽  
Low Birth Weight ◽  
Human Development ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Neonatal Morbidity ◽  
Neonatal Outcomes ◽  
Weight Outcomes

This report describes the neonatal outcomes of 1765 very low birth weight (&lt;1500 g) infants delivered from November 1987 through October 1988 at the seven participating centers of the National Institute of Child Health and Human Development Neonatal Intensive Care Network. Survival was 34% at &lt;751 g birth weight (range between centers 20% to 55%), 66% at 751 through 1000 g (range 42% to 75%), 87% at 1001 through 1250 g (range 84% to 91%), and 93% at 1251 through 1500 g (range 89% to 98%). By obstetric measures of gestation, survival was 23% at 23 weeks (range 0% to 33%), 34% at 24 weeks (range 10% to 57%), and 54% at 25 weeks (range 30% to 72%). Neonatal morbidity included respiratory distress (67%), symptomatic patent ductus arteriosus (25%), necrotizing enterocolitis (6%), septicemia (17%), meningitis (2%), urinary tract infection (4%), and intraventricular hemorrhage (45%, 18% grade III and IV). Morbidity increased with decreasing birth weight. Oxygen was administered for ≥28 days to 79% of &lt;751-g birth weight infants (range between centers 67% to 100%), 45% of 751-through 1000-g infants (range 20% to 68%), and 13% of 1001- through 1500-g infants (range 5% to 23%). Ventilator support for ≥28 days was given to 68% of infants at &lt;751 g, 29% at 751 through 1000 g, and 4% at &gt;1000 g. Hospital stay was 59 days for survivors vs 15 days for infants who died. Sixty-nine percent of survivors had subnormal (&lt;10th percentile) weight at discharge. The data demonstrate important intercenter variation of current neonatal outcomes, as well as differences in philosophy of care and definition and prevalence of morbidity.

696: Weight gain according to 2009 institute of medicine (iom) guidelines in twin pregnancies: maternal and neonatal outcomes

2015 ◽  
Vol 212 (1) ◽  
pp. S340-S341
Author(s):  
Pardis Hosseinzadeh ◽  
Bahram Salmanian ◽  
Amirhossein Moaddab ◽  
Hossein Golabbakhsh ◽  
Alireza Shamshirsaz ◽  
...  
Keyword(s):  
Weight Gain ◽  
Neonatal Outcomes ◽  
Institute Of Medicine ◽  
Maternal And Neonatal Outcomes ◽  
Twin Pregnancies

scholarly journals Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial

2017 ◽  
Vol 35 (07) ◽  
pp. 624-631 ◽  
Author(s):  
Lindsay Doherty ◽  
Jim Roberts ◽  
Leslie Myatt ◽  
Kenneth Leveno ◽  
Michael Varner ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Neonatal Intensive Care ◽  
Secondary Analysis ◽  
Preterm Births ◽  
Neonatal Outcomes ◽  
Composite Outcome ◽  
Spontaneous Preterm Birth ◽  
Membrane Rupture ◽  
Nulliparous Women ◽  
Maternal And Neonatal Outcomes

Objective To compare the risks of adverse maternal and neonatal outcomes associated with spontaneous (SPTB) versus indicated preterm births (IPTB). Methods A secondary analysis of a multicenter trial of vitamin C and E supplementation in healthy low-risk nulliparous women. Outcomes were compared between women with SPTB (due to spontaneous membrane rupture or labor) and those with IPTB (due to medical or obstetric complications). A primary maternal composite outcome included: death, pulmonary edema, blood transfusion, adult respiratory distress syndrome (RDS), cerebrovascular accident, acute tubular necrosis, disseminated intravascular coagulopathy, or liver rupture. A neonatal composite outcome included: neonatal death, RDS, grades III or IV intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis (NEC), or retinopathy of prematurity. Results Of 9,867 women, 10.4% (N = 1,038) were PTBs; 32.7% (n = 340) IPTBs and 67.3% (n = 698) SPTBs. Compared with SPTB, the composite maternal outcome was more frequent in IPTB—4.4% versus 0.9% (adjusted odds ratio [aOR], 4.0; 95% confidence interval [CI], 1.4–11.8), as were blood transfusion and prolonged hospital stay (3.2 and 3.7 times, respectively). The frequency of composite neonatal outcome was higher in IPTBs (aOR, 1.8; 95% CI, 1.1–3.0), as were RDS (1.7 times), small for gestational age (SGA) < 5th percentile (7.9 times), and neonatal intensive care unit (NICU) admission (1.8 times). Conclusion Adverse maternal and neonatal outcomes were significantly more likely with IPTB than with SPTB.

scholarly journals A study of various neonatal outcomes and complications in live-born infants among IVF pregnancies

2021 ◽  
Vol 10 (6) ◽  
pp. 2330
Author(s):  
Chetan Yadav ◽  
Charu Yadav
Keyword(s):  
In Vitro Fertilization ◽  
Neonatal Intensive Care ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Advanced Technique ◽  
Vitro Fertilization ◽  
Army Hospital ◽  
Reproductive Techniques ◽  
Twin Pregnancies

Background: In-vitro fertilization or Assisted reproductive techniques (ART) is the most advanced technique of infertility treatment. In-vitro fertilization (IVF) has helped couples all over the world. However, the use of IVF has raised significant concern about the outcome of resulting pregnancies and the health of the newborns. There is a range of possible factors associated with the treatment that may contribute to potential adverse outcomes. Thus, the study was conducted to analyze the neonatal outcomes of children born by ART in the Indian context.Methods: The neonatal characteristics and complications of the live-born infants through IVF at Army Hospital R and R were analyzed in this study between March 2019 to February 2020.Results: Total 231 babies were born to the study group cases. 126 (54.54%) were singletons, 102 (44.16%) were of twin pregnancies and 1.3% were triplets. There were 65.36% term and 34.63% preterm. Of the 231 IVF neonates, 58 needed neonatal intensive care. There were 219 (94.8%) survivors, while 12 (5.2%) did not survive a week. The 16 (6.92%) survivors needed readmissions mainly due to hyperbilirubinemia. There were 106 (45.8%) babies whose weight was less than 2 kg.Conclusions: Infertility cases are usually older, and this is one reason for increased pregnancy and newborn infant complications. Neonates born through IVF appeared to be at higher risk of multiple births, prematurity, low birth weight, and other disabilities.

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