scholarly journals Challenges and prospects of preterm birth prediction in multiple pregnancies

2018 ◽  
Vol 67 (4) ◽  
pp. 48-59 ◽  
Author(s):  
Olga V Kosyakova ◽  
Olesya N Bespalova
Keyword(s):  
Preterm Birth ◽  
Metabolic Disorders ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
High Rate ◽  
Premature Births ◽  
Multiple Pregnancies ◽  
Priority Task ◽  
Adverse Perinatal Outcomes ◽  
High Level

For today, twins make up about 1.5% of the population of our planet. It is more than one hundred million people, which in number corresponds to the population of two Frances. The number of twins born relative to the total number of newborns in different countries and on different continents is different, but the overall trend is that it continues to grow. In recent years, the percentage of multiple pregnancy has increased almost 2.5 times, which is associated with the widespread use of assisted reproductive technologies.At the same time, pregnancy in multiple births is an extremely important problem in modern obstetrics, as it is accompanied by a high level of complications for both the mother and the fetuses. Multiple pregnancy contributes significantly to the formation of adverse perinatal outcomes, which is primarily due to the high rate of preterm birth. Premature twins are at high risk of neurological and neuropsychiatric disorders, respiratory distress, endocrine and metabolic disorders, which subsequently become the cause of disability and social maladaptation of children. In this regard, the reduction in the number of premature births is today a priority task, the solution of which is possible only through timely and correct forecasting. The multifactority of pathogenic mechanisms determines the necessity of diagnostic search strategies that can identify markers of various pathogenetic ways of preterm birth. (For citation: Kosyakova OV, Bespalova ОN. Challenges and prospects of preterm birth prediction in multiple pregnancies. Journal of Obstetrics and Women’s Diseases. 2018;67(4):48-59. doi: 10.17816/JOWD67448-59).

scholarly journals Prevention and therapy of threatened preterm birth in multiple pregnancy

2019 ◽  
Vol 68 (4) ◽  
pp. 55-70
Author(s):  
Olga V. Kosyakova ◽  
Olesya N. Bespalova
Keyword(s):  
Preterm Birth ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Bed Rest ◽  
Good Evidence ◽  
Therapeutic Interventions ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Multiple Pregnancies ◽  
Adequate Treatment

Preterm birth in multiple pregnancy is an important medical, economic and social problem. Currently, more than half of twins are born prematurely, which puts them at high risk of developing neonatal diseases causing lifelong disability and social maladjustment. In this regard, reducing the frequency of preterm multiple births is an important task of modern obstetrics. Improving perinatal outcomes of multiple pregnancies can only be achieved using the most effective measures that have a good evidence base. At the same time, numerous studies on the effectiveness of therapeutic interventions aimed at prolonging multiple pregnancies have reported contradictory results. This review included most of the randomized controlled trials of methods for the prevention and treatment of threatening preterm birth in multiple pregnancies, as available in PubMed, Google Academy, Elibrary, and the Cochrane Central Register of Controlled Trials. Thus far, studies on the use of bed rest, prophylactic tocolysis, most of the progestins, and cervical cerclage in multiple pregnancy have shown no efficacy in reducing the risk of premature birth. However, encouraging data were obtained on improving neonatal outcomes of multiple pregnancies using vaginal progesterone and an obstetric pessary, but these results require additional confirmation in larger multicenter randomized studies. Further clinical trials are needed to develop algorithms for timely diagnosis and adequate treatment of threatened preterm birth in case of multiple pregnancy, including the use of the most rational preventive and therapeutic methods that have a high evidence level.

scholarly journals Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Na Zeng ◽  
Erica Erwin ◽  
Wendy Wen ◽  
Daniel J. Corsi ◽  
Shi Wu Wen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Adverse Perinatal Outcomes

Abstract Background Racial disparities in adverse perinatal outcomes have been studied in other countries, but little has been done for the Canadian population. In this study, we sought to examine the disparities in adverse perinatal outcomes between Asians and Caucasians in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Asian and Caucasian women who attended a prenatal screening and resulted in a singleton birth in an Ontario hospital (April 1st, 2015-March 31st, 2017). Generalized estimating equation models were used to estimate the independent adjusted relative risks and adjusted risk difference of adverse perinatal outcomes for Asians compared with Caucasians. Results Among 237,293 eligible women, 31% were Asian and 69% were Caucasian. Asians were at an increased risk of gestational diabetes mellitus, placental previa, early preterm birth (< 32 weeks), preterm birth, emergency cesarean section, 3rd and 4th degree perineal tears, low birth weight (< 2500 g, < 1500 g), small-for-gestational-age (<10th percentile, <3rd percentile), neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment, but had lower risks of preeclampsia, macrosomia (birth weight > 4000 g), large-for-gestational-age neonates, 5-min Apgar score < 7, and arterial cord pH ≤7.1, as compared with Caucasians. No difference in risk of elective cesarean section was observed between Asians and Caucasians. Conclusion There are significant differences in several adverse perinatal outcomes between Asians and Caucasians. These differences should be taken into consideration for clinical practices due to the large Asian population in Canada.

Preterm labour in multiple pregnancies

1993 ◽  
Vol 5 (2) ◽  
pp. 105-119 ◽  
Author(s):  
James P Neilson ◽  
Caroline A Crowther
Keyword(s):  
Perinatal Mortality ◽  
Preterm Labour ◽  
Multiple Pregnancy ◽  
High Rate ◽  
Fetal Malformation ◽  
Multiple Pregnancies ◽  
Neonatal Deaths ◽  
Late Abortion ◽  
Early Neonatal Deaths ◽  
Singleton Pregnancies

Multiple pregnancy is associated with a high rate of perinatal loss – mainly due to preterm labour but with important contributions from fetal malformation, intrauterine growth retardation and twin-twin transfusion syndrome. The overall perinatal mortality rate is consistently around six times that of singleton pregnancies but the rate rises progressively with the number of fetuses. Rates of 63,164,200,214 and 416 per 1000 births have been recently reported for twins, triplets, quadruplets, quintuplets and sextuplets respectively. In addition to these alarming figures, it should be emphasized that the restricted concept of perinatal mortality obscures the real extent of loss. If we include late abortion (after 20 weeks), late neonatal deaths and deaths in infancy from perinatal causes, as well as the usual indices of perinatal mortality (stillbirths and early neonatal deaths) we find that the total loss rate from twin pregnancy alone doubles and may be close to 10%. Although the rate of loss from multiple pregnancies is now substantially higher than that associated with the pregnancies of diabetic women, the challenge of multiple pregnancy has not been met with the same commitment or organisation of specialized perinatal services as has diabetes.

Adverse perinatal outcomes of chlamydia infections: an ongoing challenge

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Yael Eliner ◽  
Moti Gulersen ◽  
Amos Grunebaum ◽  
Erez Lenchner ◽  
Liron Bar-El ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Perinatal Outcomes ◽  
The United States ◽  
Chlamydia Infection ◽  
Suspected Sepsis ◽  
Bonferroni Adjustment ◽  
Neonatal Ventilation ◽  
Adverse Perinatal Outcomes

Abstract Objectives Chlamydia trachomatis is one of the most common sexually transmitted diseases in the world, but there are limited data on its impact on perinatal outcomes. Our objective was to investigate the association between chlamydia infections and adverse perinatal outcomes. Methods This is a retrospective analysis of the United States Centers for Disease Control and Prevention natality live birth database for the years 2016–2019. The rates of adverse perinatal outcomes were compared between patients with a chlamydia infection during pregnancy and patients without such infection, using Pearson’s chi-square test with the Bonferroni adjustment. A multivariate logistic regression was then used to adjust outcomes for potential confounders. Results Chlamydia infections were associated with small, but statistically significant, increased odds of preterm birth (<37 weeks), early preterm birth (<32 weeks), low birthweight (<2,500 g), congenital anomalies, low 5-min Apgar score (<7), neonatal intensive care unit admission, immediate neonatal ventilation, prolonged (>6 h) neonatal ventilation, and neonatal antibiotic treatment for suspected sepsis. Conclusions Chlamydia infections during pregnancy are associated with adverse perinatal outcomes. These results call for increased education regarding the potential risks of pregnancies with a chlamydia infection, as well as for increased antenatal surveillance and post-natal pediatric assessment in these pregnancies.

Placenta as a target organ for maternal obesity

2021 ◽  
Vol 20 (5) ◽  
pp. 93-99
Author(s):  
N.N. Smirnova ◽  
◽  
N.B. Kuprienko ◽  
V.P. Novikova ◽  
A.I. Khavkin ◽  
...  
Keyword(s):  
Amino Acid ◽  
Cardiovascular Diseases ◽  
Metabolic Disorders ◽  
Maternal Obesity ◽  
Morphological Structure ◽  
Perinatal Outcomes ◽  
Target Organ ◽  
Placental Function ◽  
Adverse Perinatal Outcomes ◽  
Inflammatory Changes

Maternal obesity is associated with pregnancy complications and increases the risk of obesity, diabetes, and cardiovascular diseases in children later in life. The risk of adverse perinatal outcomes in maternal obesity is associated with changes in placental function and morphological structure, including decidual arteriopathy and placental infarction, increased placental disc mass (>90th percentile) and chronic inflammation of villi with a decrease in their number. Maternal obesity is associated with placental hypoxia, intense angiogenesis, and increased levels of glucose and amino acid transporter transcripts, which can cause fetal metabolic disorders. It was found that maternal obesity more often leads to inflammatory changes in the placenta of female fetuses. The review describes the main adipokines operating in the maternal-placental-fetal system: leptin, adiponectin, chemerin, visfatin, resistin, and apelin. Conclusion. The analysis of the literature enabled to identify the main statements characterizing the placenta as a target organ and an organ that changes fetal metabolism in case of maternal obesity. This reveals the prospects for therapeutic intervention since timely initiated dietary correction of obesity can improve the course and prognosis of pregnancy and reduce the risk of adverse effects of intrauterine factors on the fetus. Key words: adipokines, maternal obesity, fetal metabolic disorders, perinatal outcomes

scholarly journals Effect of antibiotics on inflammatory marker (IL-6) and perinatal outcomes in women with preterm premature rupture of membranes

2018 ◽  
Vol 7 (10) ◽  
pp. 4068
Author(s):  
Ashima Arora ◽  
Ratna Biswas ◽  
Bhawna Dubey ◽  
Binita Goswami ◽  
Sonal Saxena
Keyword(s):  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Inflammatory Marker ◽  
Perinatal Outcomes ◽  
Admission Rate ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Adverse Perinatal Outcomes ◽  
High Level

Background: The aim is to study the effect of antibiotics on inflammatory marker (IL-6) and perinatal outcomes in women with preterm premature rupture of membranes (PPROM).Methods: 60 women with PPROM at 28–34 weeks of gestation were enrolled in the study. All the women were given antibiotics as per hospital protocol and were subjected to blood sampling for Interleukin -6(IL-6) at admission, delivery and umbilical cord blood. IL-6 levels were assessed for associations with adverse perinatal outcomes and the effect of antibiotic treatment on IL-6 and perinatal outcomes were studied. The data were analyzed using t test and χ2 test.Results: Increased level of IL-6 was associated with chorioamnionitis and neonatal sepsis (p<0.001). High level of IL-6 led to early delivery and complete course of antibiotics suppressed IL-6 (p<0.001) and clinical chorioamnionitis in women with PROM. Full course of antibiotics also decreased the admission rate of babies to neonatal intensive care unit and suppressed respiratory distress syndrome, neonatal sepsis.Conclusions: Increased level of IL-6 is seen in women with chorioamnionitis and neonatal sepsis. Antibiotics suppress the IL-6 levels, chorioamnionitis and neonatal sepsis.

scholarly journals Obstetric and perinatal outcomes in women with multiple pregnancy in Altai region

2019 ◽  
Vol 4 (3) ◽  
pp. 27-33
Author(s):  
S. V. Barinov ◽  
A. A. Belinina ◽  
I. V. Molchanova ◽  
O. V. Kolyado
Keyword(s):  
Preterm Birth ◽  
Ultrasound Examination ◽  
Multiple Pregnancy ◽  
Significant Risk ◽  
Perinatal Outcomes ◽  
Significant Risk Factor ◽  
Singleton Pregnancy ◽  
Altai Region ◽  
Cervical Pessary ◽  
Somatic Diseases

Aim. To study complications and perinatal outcomes of multiple pregnancy in women of the Altai Region.Materials and Methods. We recruited 678 consecutive pregnant women, including 378 with multiple pregnancy, with the subsequent analysis of clinical and ultrasound examination data as well as perinatal outcomes.Results. Women with multiple pregnancy were characterised by a significantly higher rate of gynecological and somatic diseases including pregnancy-related anemia (20.2% versus 4.3% in women with multiple and singleton pregnancy, respectively, OR = 6.0, 95% CI = 3.2-11.3). Further, multiple pregnancy was a significant risk factor for preterm birth (62.26% and 21.82%, respectively, OR = 5.9, 95% CI = 4.2-8.4, p ≤ 0.001). Application of cervical pessary was able to prolong the multiple pregnancy for 4 weeks.Conclusion. Prevention of threatening preterm birth in women with a multiple pregnancy using a cervical pessary improves perinatal outcomes. 

scholarly journals The predictors of preterm labour in patients with multiple pregnancy

2020 ◽  
pp. 144-150
Author(s):  
S. V. Barinov ◽  
A. A. Belinina ◽  
O. V. Koliado ◽  
I. V. Molchanova ◽  
A. A. Shkret ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Assisted Reproductive Technologies ◽  
Preterm Labour ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Risk Groups ◽  
Reproductive Technologies ◽  
Cervical Insufficiency ◽  
Logistic Analysis ◽  
Prophylactic Measures

Introduction. The number of women with multiple pregnancy is increasing worldwide, especially in countries with a high level of health care, where assisted reproductive technologies are widely used. According to foreign studies, one third of twins are born as a result of Assisted Reproductive Technologies (ART), so only an increase in multiple pregnancy can be predicted in the future. The main obstetric problem with these pregnancies is the problem of carrying.Objective: To identify the predictors of preterm birth in patients with multiple pregnancy in order to improve monitoring and prophylactic measures among this cohort of women.Material and methods: A retrospective controlled observational study, including 154 patients with multiple pregnancies was carried out. Logistic analysis was used to identify the predictors of preterm labour.Results: The study showed that the predictors of preterm birth varied from one trimester to another. Based on the identified predictors, the predictive models for each trimester of pregnancy were compiled. Most of the identified predictors are related to obstetrical history. Risk groups formation, based on the identification of these predictors, is extremely important for qualified medical support. Prophylactic measures should be performed on the pre-conceptional stage. Pregnancy planning should be recommended only after treatment of chronic endometritis, followed by control of vaginal microflora and progesterone support. It is hardly possible to talk about the prevention of cervical insufficiency. However, cervical correction is an important factor for perinatal outcomes improving. The research suggests that the insertion of cervical pessary in women with multiple pregnancy and cervical insufficiency allows to prolong the gestational period for 7 weeks.Conclusion: a comprehensive approach of management of women with multiple pregnancy based on the prognostic scales of preterm labour, allows to reduce the preterm birth rate.

scholarly journals Benefits of not smoking during pregnancy for Australian Aboriginal and Torres Strait Islander women and their babies: a retrospective cohort study using linked data

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032763 ◽  
Author(s):  
Carol McInerney ◽  
Ibinabo Ibiebele ◽  
Jane B Ford ◽  
Deborah Randall ◽  
Jonathan M Morris ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Lower Risk ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Smoking During Pregnancy ◽  
Relative Risks ◽  
South Wales ◽  
Adverse Perinatal Outcomes

ObjectivesTo provide evidence for targeted smoking cessation policy, the aim of this study was to compare pregnancy outcomes of Aboriginal mothers who reported not smoking during pregnancy with Aboriginal mothers who reported smoking during pregnancy.DesignPopulation based retrospective cohort study using linked data.SettingNew South Wales, the most populous Australian state.Population18 154 singleton babies born to 13 477 Aboriginal mothers between 2010 and 2014 were identified from routinely collected New South Wales datasets. Aboriginality was determined from birth records and from four linked datasets through an Enhanced Reporting of Aboriginality algorithm.ExposureNot smoking at any time during pregnancy.Main outcome measuresUnadjusted and adjusted relative risks (aRR) and 95% CIs from modified Poisson regression were used to examine associations between not smoking during pregnancy and maternal and perinatal outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated using adjusted relative risks.ResultsCompared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR=0.58, 95% CI 0.44 to 0.76), preterm birth (aRR=0.58, 95% CI 0.53 to 0.64) and small-for-gestational age (aRR=0.35, 95% CI 0.32 to 0.39). PAFs (%) were 27% for perinatal death, 26% for preterm birth and 48% for small-for-gestational-age. Compared with women who smoked during pregnancy (n=8919), those who did not smoke (n=9235) had a lower risk of being transferred to another hospital (aRR=0.76, 95% CI 0.66 to 0.89).ConclusionsBabies born to women who did not smoke during pregnancy had a lower risk of adverse perinatal outcomes. Rates of adverse outcomes among Aboriginal non-smokers were similar to those among the general population. These results quantify the proportion of adverse perinatal outcomes due to smoking and highlight why effective smoking cessation programme are urgently required for this population.

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