Prevention and therapy of threatened preterm birth in multiple pregnancy

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.

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Challenges and prospects of preterm birth prediction in multiple pregnancies

Journal of obstetrics and women s diseases ◽

10.17816/jowd67448-59 ◽

2018 ◽

Vol 67 (4) ◽

pp. 48-59 ◽

Cited By ~ 2

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).

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

Fundamental and Clinical Medicine ◽

10.23946/2500-0764-2019-4-3-27-33 ◽

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.

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The predictors of preterm labour in patients with multiple pregnancy

Medical Council ◽

10.21518/2079-701x-2020-3-144-150 ◽

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.

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Prevention of recurrent miscarriage in women with antiphospholipid syndrome: A systematic review and network meta-analysis

Lupus ◽

10.1177/0961203320967097 ◽

2020 ◽

Vol 30 (1) ◽

pp. 70-79

Author(s):

Ziyi Yang ◽

Xiangli Shen ◽

Chuqing Zhou ◽

Min Wang ◽

Yi Liu ◽

...

Keyword(s):

Preterm Birth ◽

Antiphospholipid Syndrome ◽

Live Birth ◽

Birth Rate ◽

Recurrent Miscarriage ◽

Live Birth Rate ◽

Controlled Trials ◽

Cochrane Central Register ◽

Pharmacological Interventions ◽

Significant Difference

Objectives To compare and rank currently available pharmacological interventions for the prevention of recurrent miscarriage (RM) in women with antiphospholipid syndrome (APS). Methods A search was performed using PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, CNKI, ClinicalTrials.gov, and the UK National Research Register on December 15, 2019. Studies comparing any types of active interventions with placebo/inactive control or another active intervention for the prevention of RM in patients with APS were considered for inclusion. The primary outcomes were efficacy (measured by live birth rate) and acceptability (measured by all-cause discontinuation); secondary outcomes were birthweight, preterm birth, preeclampsia, and intrauterine growth retardation. The protocol of this study was registered with Open Science Framework (DOI: 10.17605/OSF.IO/B9T4E). Results In total, 54 randomized controlled trials (RCTs) comprising 4,957 participants were included. Low-molecular-weight heparin (LMWH) alone, aspirin plus LMWH or unfractionated heparin (UFH), aspirin plus LMWH plus intravenous immunoglobulin (IVIG), aspirin plus LMWH plus IVIG plus prednisone were found to be effective pharmacological interventions for increasing live birth rate (ORs ranging between 2.88 to 11.24). In terms of acceptability, no significant difference was found between treatments. In terms of adverse perinatal outcomes, aspirin alone was associated with a higher risk of preterm birth than aspirin plus LMWH (OR 3.92, 95% CI 1.16 to 16.44) and with lower birthweight than LMWH (SMD −808.76, 95% CI −1596.54 to −5.07). Conclusions Our findings support the use of low-dose aspirin plus heparin as the first-line treatment for prevention of RM in women with APS, and support the efficacy of hydroxychloroquine, IVIG, and prednisone when added to current treatment regimens. More large-scale, high-quality RCTs are needed to confirm these findings, and new pharmacological options should be further evaluated.

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Does Thromboprophylaxis Reduce Mortality in Medical Patients? A Systematic Review and Meta-Analysis of Randomized Cntrolled Tials.

Blood ◽

10.1182/blood.v106.11.905.905 ◽

2005 ◽

Vol 106 (11) ◽

pp. 905-905

Author(s):

Francesco Dentali ◽

Monica Gianni ◽

Wendy Lim ◽

James D. Douketis

Keyword(s):

Venous Thromboembolism ◽

Major Bleeding ◽

Meta Analysis ◽

Good Evidence ◽

Controlled Trials ◽

Cochrane Central Register ◽

Medical Patients ◽

Central Register ◽

Increased Risk ◽

Patients At Risk

Abstract Background: Despite good evidence that anticoagulants are effective in preventing venous thromboembolism in medical patients at risk for this disease, only one-third of such patients are receiving thromboprophylaxis. Underutilization of thromboprophylaxis in medical patients may be due to lack of evidence that thromboprophylaxis reduces mortality, concerns about anticoagulant-related bleeding, and questions about the clinical significance of surrogate (venographic) outcomes to assess efficacy in these trials. We performed a meta-analysis of randomized, placebo-controlled trials of anticoagulant thromboprophylaxis in medical patients to assess effects on mortality and bleeding. Methods: The MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases were searched until June 2005. Studies were included that were randomized, placebo-controlled trials investigated a prophylactic dose of unfractionated heparin, low-molecular-weight heparin, or fondaparinux in medical patients. Meta-analysis was done to obtain pooled estimates of the effects of anticoagulant thromboprophylaxis on mortality and clinically important (major) bleeding. The effect of treatment on venous thromboembolism was not pooled because of across-study difference in methods used to diagnose this, and use of asymptomatic (venographic) outcomes in some studies. Results: There were 8 studies of 20,631 patients in the assessment of mortality and 4 studies of 5,428 patients in the assessment of major bleeding. Death occurred in 536 of 10,321 (5.2%) patients who received thromboprophylaxis, and in 608 of 10,510 (5.8%) who received placebo. Thromboprophylaxis was associated with 10% decreased risk for all-cause mortality, although this effect was not quite statistically significant (odds ratio [OR] = 0.90; 95% confidence interval [CI]: 0.81, 1.01). Major bleeding occurred in 22 of 2,726 (0.8%) patients who received thromboprophylaxis, and in 11 of 2,702 (0.4%) patients who received placebo. Thromboprophylaxis was associated with 2-fold increased risk for major bleeding, although this effect was not quite statistically significant (OR = 2.04; 95% CI: 0.98, 4.23). Conclusion: In medical patients who are at increased risk for venous thromboembolism, anticoagulant thromboprophylaxis appears to confer a small reduction in mortality; this benefit should be balanced against an increased risk for major bleeding.

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Risks and challenges in multiple pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20214666 ◽

2021 ◽

Vol 10 (12) ◽

pp. 4578

Author(s):

Aditi Agarwal ◽

Arti Sharma ◽

Neeta Bansal ◽

Neha Panwar ◽

Shweta Singh ◽

...

Keyword(s):

Placenta Previa ◽

Multiple Pregnancy ◽

Perinatal Outcomes ◽

Obstetric Care ◽

Elevated Risk ◽

Multiple Pregnancies ◽

Triplet Pregnancy ◽

Mother And Child ◽

Fetal Complications ◽

Fetal Malformations

Because of breakthroughs in reproductive medicine, multiple pregnancies have become more common in the industrialized world. As a result, obstetric care for women with multiple pregnancies and neonatal care for the same has become more demanding. Multifetal pregnancies are linked to an elevated risk for both the mother and child. There is increased incidence of obstetric complications such as spontaneous abortion, hypertensive disorders, placenta previa, and fetal malformations. Perinatal outcome is also affected which is attributable to increased incidence of fetal complications like prematurity, congenital malformations, growth discordance and cord accidents. We are presenting 2 cases, one of MCMA twin pregnancy with fetal congenital anomaly and another of a triplet pregnancy and their perinatal outcomes.

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MULTIPLE PREGNANCY, ANTENATAL CARE PROBLEMS AND THEIR SOLUTIONS RESULTS

EUREKA Health Sciences ◽

10.21303/2504-5679.2017.00278 ◽

2017 ◽

Vol 1 ◽

pp. 39-45

Author(s):

Iryna Nikitina ◽

Natalya Kalashnyk ◽

Svitlana Smiian ◽

Tatyana Babar ◽

Alina Popova

Keyword(s):

Transvaginal Ultrasound ◽

Multiple Pregnancy ◽

Perinatal Outcomes ◽

Statistical Processing ◽

Multiple Pregnancies ◽

Perinatal Complications ◽

Singleton Pregnancy ◽

Monochorionic Twins ◽

Pregnancy And Childbirth ◽

Ultrasound Monitoring

Aim of the work. The aim of our study is to summarize the course of pregnancy and delivery in multiple pregnancies in modern conditions. Materials and methods. The analysis of the pregnancy course, labor and perinatal outcomes was carried out in 182 women with diochorionic and 86 patients with monochorionic twins and 40 women with a singleton pregnancy. Multiple pregnancies were proved to be a monochorionic (MH) and diochorionic (DH) that is a high risk factor for perinatal complications. The research included clinical and laboratory examination metods, study of hormonal function of fetoplacental complex (FPC), transvaginal ultrasound examination. Statistical processing of data was carried out using the package of applied programs Microsoft Office Excel 2010 and StatSoft Statistica 6.1. Results and discussion. In the analysis of pregnancy the abortion threat was detected in 51 (59.3%) women with monochorionic and 34 (62%) women with diochorionic twins. Preeclampsia during pregnancy complicated in 26 (30.2%) and 43 (23.6%) patients, with monochorionic and diochorionic placentation type, respectively. A frequent complication of both the MH and DH twins was anemia, which was found in more than half of the surveyed (56.9 and 51%, respectively). Delivery in the case of multiple pregnancies is also much more complicated and is terminated surgically three times more often than in singleton births. The most frequent indications for operative delivery were first breech fetus, fetal distress during pregnancy and childbirth, FGR, severe preeclampsia, premature detachment of normally situated placenta, anomalies of labor activity. These perinatal losses were equally observed both after cesarean section and after spontaneous labor and amounted to 4% at monochorionic and 1.7% at diochorionic twins. The frequency dependence of identified lesions at pregnancy with twins was established by chorionic. Careful observation of the patients with multiple pregnancies in the antenatal period, the prevention of the most frequent complications, ultrasound monitoring of early pregnancy allows a differentiated approach to the management of pregnancy and childbirth, helping to reduce perinatal morbidity and mortality. Conclusions. Multiple pregnancies occur with a large number of complications compared with singletons. Thus, the increase of frequency of multiple pregnancy influences the obstetric and perinatal indicators, pushing this issue in a number of the most pressing issues of modern obstetrics and perinatology.

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Preterm birth in singleton and multiple pregnancies: evaluation of costs and perinatal outcomes

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2014.12.024 ◽

2015 ◽

Vol 186 ◽

pp. 34-41 ◽

Cited By ~ 14

Author(s):

Gert J. van Baaren ◽

Myrthe J.C.S. Peelen ◽

Ewoud Schuit ◽

Joris A.M. van der Post ◽

Ben W.J. Mol ◽

...

Keyword(s):

Preterm Birth ◽

Perinatal Outcomes ◽

Multiple Pregnancies

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Role of Ultrasound in Diagnosis of Fetus Acardius Acephalus in Multiple Pregnancies

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0039-1677781 ◽

2018 ◽

Vol 4 (02) ◽

pp. 085-087

Author(s):

Ruby Yadav ◽

Nishi Choudhary

Keyword(s):

Heart Failure ◽

Case Report ◽

Gestational Age ◽

Preterm Labor ◽

Perinatal Outcomes ◽

Therapeutic Interventions ◽

Multiple Pregnancies ◽

Triplet Pregnancy ◽

Gestational Age At Delivery

AbstractThis case report describes an acardiac fetus of the acephalus phenotype in a triplet pregnancy. The diagnosis was confirmed at 13 weeks. In the absence of signs of heart failure in the co-fetus, the pregnancy was managed conservatively. The pregnancy was complicated by preterm labor and the fetuses were delivered at 23 + 4 weeks. Also, the perinatal outcomes of triplet pregnancies complicated by an acardiac fetus, where the median gestational age at delivery is 23 to 24 weeks, are summarized, and the possible therapeutic interventions have been discussed.

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Multiple pregnancy

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0020 ◽

2020 ◽

pp. 253-267

Author(s):

Surabhi Nanda ◽

James P. Neilson

Keyword(s):

Preterm Birth ◽

Multiple Pregnancy ◽

Multiple Pregnancies ◽

Hypertensive Disorders Of Pregnancy ◽

Maternal Complications ◽

Singleton Pregnancy ◽

Birth Complications ◽

Hypertensive Disorders ◽

Increased Risk ◽

Need Support

There has been a consistent rise in multiple pregnancies over recent years. Such pregnancies are at increased risk of miscarriage, fetal abnormalities, preterm birth, complications specific to shared placentation including twin-to-twin transfusion syndrome, selective growth restriction, and twin anaemia–polycythaemia sequence. In addition, a woman with a multiple pregnancy is at a higher risk of maternal complications including pre-eclampsia and other hypertensive disorders of pregnancy, obstetric cholestasis, gestational diabetes, exaggerated maternal pregnancy symptoms, and postpartum haemorrhage. Antenatal care in a multiple pregnancy should ideally be offered in a dedicated setting, with increased contact with the healthcare professionals compared to a singleton pregnancy. Such pregnancies, especially when complicated, need support and appropriate counselling to prepare for an optimal outcome.

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