scholarly journals Outcomes of transvaginal multifetal pregnancy reduction without injecting potassium chloride

2016 ◽  
Vol 6 (1) ◽  
pp. 182
Author(s):  
Devika Gunasheela ◽  
Sneha Rao ◽  
Geethika Jain ◽  
Anitha GS
Keyword(s):  
Birth Weight ◽  
Preterm Delivery ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
Abortion Rate ◽  
Control Group ◽  
Fetal Reduction ◽  
Reduced Group ◽  
Multifetal Pregnancy ◽  
Multifetal Pregnancy Reduction

Background: Assisted reproductive technologies and the use of fertility drugs have significantly increased the prevalence of multiple pregnancy in last three decades. Various techniques and routes have been studied so far regarding fetal reduction to achieve healthy viable pregnancy. The current study aims to study different outcomes of multifetal pregnancy reduction without injecting potassium chloride.Methods: Total 57 patients were studied from October 2011 to November 2012 at our centre. 28 were higher order pregnancies who consented for fetal reduction and 29 were nonreduced twins as control group. It was a prospective comparative study. Fetal reduction was done transvaginally between 8-12 weeks by intracardiac puncture followed by manual aspiration of embryonic parts till asystole. Use of KCl was avoided. The most easily accessible sac was chosen for reduction. All were reduced to twins. Reduction to singleton and selective reduction of anomalous fetus were removed from the study as it could have created a bias in the comparison. The primary outcomes like miscarriage, post procedure complications, mean gestational age at delivery, preterm delivery, mean birth weight were studied. The outcomes of reduced twins were compared with that of nonreduced twins. The various secondary outcomes like IUGR, take home baby rate, neonatal morbidity, mortality, maternal morbidity and mortality, associated obstetric complications were studied.Results: Both groups were comparable with respect to age and parity. The average gestation of fetal reduction was 9.46 weeks. Abortion rate was 17.9% (n=5) in reduced group which was statistically significant. 4 patients were lost to follow up. There were no statistically significant differences with regard to cesarean section rate, preterm delivery, mean birth weight, mean gestational delivery between two groups. No incidence of IUGR in the series. One baby died in the control group, none in reduced group. Take home baby rate 79.1%. Overall the antenatal and post-operative complications were higher in control group than in reduced but it was not statistically significant.Conclusions: Fetal reduction is a feasible option for triplets and higher orders multiple pregnancies. Use of KCl is not mandatory for multifetal pregnancy reduction. It is best avoided as there are increased rates of preterm labour and PPROM. There is increase in abortion rate after multifetal pregnancy reduction in comparison to nonreduced twins. So couple should be counseled about the probability of losing the entire pregnancy. The obstetric and neonatal outcomes of reduced and nonreduced twins are comparable, thus fetal reduction as a procedure is not adding any extra risk on pregnancy outcome.

scholarly journals Safety and Efficacy of Higher Order Multifetal Pregnancy Reduction: A Single-Center Retrospective Study

2020 ◽  
Vol 10 (03) ◽  
pp. e228-e233
Author(s):  
Yan Liu ◽  
Xie Tong Wang ◽  
Hong Yan Li ◽  
Hai Yan Hou ◽  
Hong Wang ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Birth Weight ◽  
Pregnancy Loss ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Higher Order ◽  
Sample Population ◽  
Safety And Efficacy ◽  
Multifetal Pregnancy ◽  
Multifetal Pregnancy Reduction

Abstract Objective This research was aimed to study the safety and efficacy of higher order multifetal pregnancy reduction (MFPR). Study Design This was a retrospective study of patients from an academic maternity center between 2005 and 2015. We evaluated outcomes of 131 consecutive patients who underwent higher order MFPR (quadruplets and greater). MFPR was performed at 11 to 18 weeks of gestation in all cases. In total, 122 of 131 cases of higher order multiple pregnancy were reduced to twins. We discuss the perinatal outcomes of patients who underwent higher order MFPR, followed by a comparative analysis between the 122 cases of MFPR that were reduced to twins and 101 cases of nonreduced twin pregnancies. Results The study included 104 sets of quadruplets, 20 sets of quintuplets, 5 sets of sextuplets, 1 set of septuplets, and 1 set of octuplets. The perinatal outcomes of the 131 cases were as follows: pregnancy loss, preterm deliveries at 28 to 33 (+6/7) weeks, and preterm deliveries at 34 to 36 (+6/7) weeks occurred in 23.66, 9, and 37% of cases, respectively. The mean time of delivery was 36.56 ± 1.77 weeks, and mean birth weight was 2,409.90 ± 458.16 g, respectively. A total of 122 cases that were reduced to twins were compared with nonreduced twins. The pregnancy loss rate for reduced twins was significantly higher than that for nonreduced twins. The preterm labor rate, mean delivery week, mean birth weight, birth-weight discordance, incidence of gestational diabetes mellitus, and pregnancy-induced hypertension were not significantly different between the groups (p > 0.05). Conclusion Perinatal outcomes were significantly improved by reducing the number of fetuses in higher order multifetal pregnancies. This study involved a large, diverse sample population, and the results can be used as a reference while conducting prenatal counseling.

MO254PREGNANCY OUTCOMES AND COMPLICATIONS IN PATIENTS WITH CHRONIC GLOMERULONEPHRITIS*

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Elena Prokopenko ◽  
Aleksei Zulkarnaev ◽  
Irina Nikol`skaya ◽  
Andrey Vatazin ◽  
Daria Penzeva
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Preterm Delivery ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Multiple Pregnancy ◽  
Chronic Glomerulonephritis ◽  
Gestational Age At Delivery ◽  
Negative Effect ◽  
Adverse Pregnancy

Abstract Background and Aims Pregnancy in patients with chronic glomerulonephritis (CGN) is associated with higher risk of complications and unfavorable outcomes compared to the general population. The aim of the study was to determine the incidence of pregnancy complications and outcomes in patients with preexisting CGN. Method 126 pregnancies in 119 women with CGN and CKD 1-4 stages: 1 st. – 86 patients, 2 st. – 17, 3 st. – 20, 4 st. – 3 and 20 pregnancies in 20 age-matching healthy women were included. Patients with secondary CGN, multiple pregnancy, pregnancy after IVF were excluded. A kidney biopsy was performed in 18 of 119 (15.1%) women: 15 – before conception and 3 – after delivery. IgA-nephropathy was detected in 11 of 18 (61.1%) patients, MCD/FSGS – in 4 (22.2%), MPGN – in 3 (16.7%). The incidence of unfavorable pregnancy outcome, preeclampsia (PE), preterm delivery, cesarean section (CS), low birth weight (LBW < 2500 g), small for gestational age (SGA) newborn (birth weight < 10th percentile), mean term of delivery, mean birth weight, frequency of treatment in neonatal intensive care unit (NICU) and achieving of end-stage kidney disease in mothers after delivery were evaluated. Results CKD was first diagnosed during pregnancy in 34.1% women with CGN. The incidence of adverse pregnancy outcomes, preterm delivery, LBW, SGA, and treatment in the NICU did not differ between groups, while the frequency of PE and CS were higher, and mean gestational age at delivery, birth weight were lower in the CGN group compared to the healthy control (Table). Severe PE was observed in 6 of 32 (18.7%) patients with PE and CGN. The incidence of PE increased in advanced stages of CKD, but the differences were not significant: 19.8% - in CKD1, 35.3% - CKD2, 35% - CKD3, 66.7% - CKD4, p=0.112. The frequency of PE depended on the presence of baseline nephrotic-range proteinuria (NPU) and chronic arterial hypertension (AH): PE was observed in women w/o NPU and w/o AH in 8.3% cases, w/o NPU and with AH – in 39%, with NPU and w/o AH – in 44,4%, with NPU and with AH – in 43.8%, p=0.00048. Preterm delivery, CS and LBW were more common in women with chronic renal failure, and their frequency increased with increasing severity of CKD: CKD1 – 3.5%, 21.2%, 3.5% resp.; CKD2 – 6.7%, 53.3%, 20%; CKD3 – 40%, 70%, 40%; CKD4 – 100%, 100%, 100% (p<0.0001, for all characteristics). We found differences in gestational age at delivery depending on the stages of CKD: in CKD1 it was 38.9 ± 1.3 wks, CKD2 – 38.2 ± 2.1 wks, CKD3 – 36.3 ± 3.5 wks, CKD4 – 32.4 wks (one child), p=0.00013. The proportion of newborns requiring intensive care was higher in mothers with CKD3 (30%) and CKD4 (100%) compared with CKD1 (0%) and CKD2 (13.3%), p<0.0001. Five of 126 (4%) patients in CGN group achieved stage 5 CKD with average postpartum follow-up period of 92.6 ± 20.5 months; 4 women had CKD3 during pregnancy, one – CKD1. Now 2 patients are treated with regular hemodialysis, 3 - live with kidney transplant. Conclusion Chronic glomerulonephritis has a negative effect on pregnancy course, increasing the incidence of PE and CS and contributing to reduce gestational age and birth weight. Incidence of preterm delivery, CS, LBW and proportion of newborns treated in NICU were highest in patients with CKD 3-4.

scholarly journals Preterm Delivery and Growth Restriction in Multifetal Pregnancies reduced to Twins: Case-Control Series

2014 ◽  
Vol 5 (2) ◽  
pp. 40-43
Author(s):  
Anuradha R Shewale ◽  
Bhavana Shewale
Keyword(s):  
Preterm Delivery ◽  
Perinatal Death ◽  
Adverse Pregnancy Outcome ◽  
Case Control ◽  
Growth Restriction ◽  
Control Group ◽  
Control Series ◽  
Increased Risk ◽  
Twin Pregnancies ◽  
Multifetal Pregnancy

ABSTRACT An adverse consequence of the widespread introduction of assisted reproductive techniques has been an exponential increase in the prevalence of multifetal pregnancies (Botting et al 1987). Such pregnancies are associated with increased risk of miscarriage and perinatal death (Kiely et al 1992). One of the options in the management of multifetal pregnancies is embryo reduction to twins which is associated with a reduction in the background risk of adverse pregnancy outcome (Evans et al 1995). The aim of the study was to compare the gestation at delivery and birth weight of surviving twins following multifetal pregnancy reduction to those in a control group of dichorionic non-reduced twins. Materials and methods A case control study evaluating pregnancy outcomes post embryo reduction. Study takes into account all patients with successful day three embryo transfers resulting in multifetal pregnancy. First trimester embryo reduction was carried out by intracardiac injection of KCl. Results A total of 26 multifetal pregnancies were reduced to twins at early gestational age (7-9 weeks). Two cases (7.6%) of miscarriage, no cases of chorioamnionitis and five cases (19.2%) of transient spotting were recorded as postoperative complications. There was no vanishing of embryos in those reduced to twins. A total of 24 patients (92.3%) with twin pregnancies took home at least one baby, while 18 (69.23%) of these took both babies home. This was analyzed and compared with a control group of women with nonreduced twins pregnancies. The preterm delivery rate (defined as fetuses delivered before 37 weeks) in twin pregnancies was 53.8% (n = 14), with a severe preterm rate (defined as fetuses delivered before 32 weeks) of 23.07% (n = 6). One case (1.92%) of stillbirth occurred. The perinatal mortality rate was 13.46% (n = 6 newborns, and a 33-week stillbirth), mainly due to severe preterm labor. The latter group included no registered cases of newborns with congenital malformations. A total of 24 patients (92.3%) with twin pregnancies took home at least one baby, while 18 (69.23%) of these took both babies home. In two of the 26 multifetal pregnancies reduced to twins there was miscarriage of both fetuses before 24 weeks of gestation the median interval between reduction and multifetal loss was 5 weeks. In pregnancy reduced to twins as compared to nonreduced twins the percentage of miscarriage was slightly higher, but not statistically significant (7.6% compared to 6.9%, 0.07 × 2, P 0.8). The median gestation at delivery was lower (33.3 ± 9.2 compared to 35.67 ± 5.84 weeks, 2.26 > 2.0 t, 0.05 P) and the median weight deficit was greater (1.58 ± 0.96 compared to 1.92 ± 0.89 (4.04 > 3.37 t, 0.001 P). How to cite this article Shewale AR, Shewale B. Preterm Delivery and Growth Restriction in Multifetal Pregnancies reduced to Twins: Case-Control Series. Int J Infertil Fetal Med 2014;5(2):40-43.

scholarly journals Etiological factors of preterm delivery

2013 ◽  
Vol 3 (2) ◽  
pp. 159-163
Author(s):  
Elvira Brkičević ◽  
Gordana Grgić ◽  
Dženita Ljuca ◽  
Edin Ostrvica ◽  
Azur Tulumović
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Preterm Delivery ◽  
Multiple Pregnancy ◽  
Neonatal Morbidity ◽  
Etiological Factor ◽  
Premature Delivery ◽  
Control Group ◽  
Etiological Factors ◽  
Experimental Group

Introduction: Preterm delivery is the delivery before 37 weeks of gestation are completed. Preterm birth is a major course of neonatal morbidity and mortality, the incidence of premature delivery in developedcountries is 5 to 9%. Aims of this study were to determine the common etiological factors for preterm delivery, most common weeks of gestation for pretern delivery, and most commom way of delivery for preterm delivery.Methods: The study included 600 patients divided into two groups, experimental group (included 300 preterm delivered pregnant women), control group (included 300 term delivered women).Results: The incidence of preterm delivery in pregnant women younger than 18 years was 4.4%, and in pregnant women older than 35 years was 14%. 44.6 % of preterm delivered women at the experimentalgroup had lower education. In the experimental group burdened obstetrical history had 29%, 17.2% had a preterm delivery, 35.6% had a premature rupture of membranes, 15% had a preterm delivery before32 weeks of gestation, 12.4% between 32-33.6 weeks of gestation, while 72.6% of deliveries were between 34- 36.6 weeks of gestation. Multiple pregnancy as an etiological factor was present in 10.07% ofcases. Extragenital diseases were present in 10.4%. In the experimental group there were 29%, while in the control group there were 15% subjects with burdened obstetrical history.Conclusions: Preterm birth more often occurs in a pregnant women younger than 18 and older than 35 years, and in a pregnant women of lower educational degree. Preterm delivery in the most commoncases was fi nished in period from 34 to 36.6 weeks of gestation. The most common etiological factor of preterm delivery in the experimental group was preterm rupture of membranes and idiopathic pretermdelivery.

scholarly journals Pregnancy outcome in isolated oligohydramnios diagnosed in third trimester

2021 ◽  
Vol 10 (5) ◽  
pp. 1914
Author(s):  
Pratibha Singh ◽  
Vibha Rani Pipal ◽  
Dharmendra Kumar Pipal ◽  
Navdeep Kaur Ghuman ◽  
Garima Yadav ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Amniotic Fluid ◽  
Pregnancy Outcome ◽  
Preterm Delivery ◽  
Neonatal Outcome ◽  
Low Risk ◽  
Control Group ◽  
P Value ◽  
Third Trimester

Background: The aim of this study was to compare the outcomes of pregnancies complicated by isolated oligohydramnios with the low risk pregnancies with normal amniotic fluid volume.Methods: The present study is a retrospective cohort study of singleton pregnancies diagnosed with Isolated oligohydramnios (AFI≤5) in their third trimester (N=35). Pregnancy outcome was compared with a matched control group of low risk pregnancies with amniotic fluid volume >5 (N=30).Results: The overall incidence of Isolated oligohydramnios was 0.7-0.8%. In oligohydramnios group, significant association were found in null-parity (60% vs 23.33%, p-value<0.005), Fetal growth retardation (25.71% vs 0% p-value<0.02), preterm delivery (22.85% vs 3.33%, p-value 0.025), rate of Induction of labor (40% vs 10%) and cesarean rate for non-reassuring fetal heart rate (20% vs 3.33%, p-value<0.001). Likewise, the incidence of low birth weight was (54.28% vs 13.33%, p-value<0.001) and NICU admissions was (20% vs 0%, p-value<0.01), but there was no difference in Apgar score finding. NICU stay was of short duration and all babies discharged in stable condition, there were no stillbirth or early neonatal death in both groups.Conclusions: Isolated oligohydramnios has an adverse influence on pregnancy and neonatal outcome in the form of FGR, preterm delivery, increased rate of Induction and cesarean section. Despite the high incidence of low birth weight and NICU admissions, the overall early neonatal outcome was similar to the other low risk pregnancies.

scholarly journals Knowledge and Attitudes of Women towards Multiple Embryo Transfer, Fetal Reduction and Multiple Pregnancy

2010 ◽  
Vol 1 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Sathya Balasubramanyam
Keyword(s):  
Preterm Delivery ◽  
Embryo Transfer ◽  
Negative Impact ◽  
Multiple Pregnancy ◽  
Single Embryo Transfer ◽  
Indian Women ◽  
Younger Women ◽  
Fetal Reduction ◽  
Knowledge And Attitudes ◽  
Positive Pregnancy Test

ABSTRACT Background Multiple pregnancy and preterm delivery are well-known complications of IVF/ICSI treatment. Fetal reduction is also performed in the cases of high order multiple pregnancy. There is increased impetus on transferring fewer embryos, preferably only one in younger women. Materials and Methods 186 women, who conceived following IVF/ICSI treatment participated in a questionnaire study regarding their knowledge and attitudes towards multiple embryo transfer, fetal reduction and multiple pregnancy Results A majority of women said that they were aware of the complications of multiple pregnancy (90%) and preterm delivery (85%). Nevertheless, none of them opted for a single embryo transfer. A positive pregnancy test was more important to most women than the outcome of that pregnancy (74%). Fetal reduction did not pose any moral concerns to most women (67%). Anxiety about the safety of the remaining twins persisted throughout pregnancy (73%). Having twin babies did not affect the quality of life of most women (74%). Conclusion Indian women were similar with their western counterparts in desiring multiple embryo transfer in order to maximize their chance of getting a positive pregnancy result. The negative impact of twin or higher order pregnancy appears to be disregarded by the women prior to getting pregnant. The confidence of the treating physician to offer single embryo transfer also appears to affect the patients’ choices.

Morphological features of the state of fetoplacental complex in women with early preterm birth after assisted reproductive technologies

2016 ◽  
pp. 79-81
Author(s):  
A.S. Mandrykova ◽  
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Main Group ◽  
Fetal Membranes ◽  
Control Group ◽  
Premature Rupture ◽  
Fetoplacental Complex ◽  
Early Preterm Birth

The objective: the study of morphofunctional changes of the fetoplacental complex at 28–33 weeks of gestation in women with early preterm delivery after the application of ART. Patients and methods. We have examined 130 patients whose pregnancy occurred after the use of ART. This is the woman who gave birth at 28–33 weeks of gestation. Of these, 80 women had early premature births in the background premature rupture of fetal membranes, 50 – patients with early preterm delivery and timely rupture of fetal membranes (control group 2). The main group included 4 groups of 20 women with regard to the duration of anhydrous interval: 1.1 – anhydrous interval 5–6 hours (main group 1); 1.2 – anhydrous span 24 hours; 1.3 – anhydrous interval 45–48 hours; 1.4 – anhydrous period 5 days after PRFM. Results. Thus, the results of the research indicate that the main cause of early preterm birth in women after using ART are structural dezorhanization changes of collagen fibers of the connective tissue amnion and chorionic which lead to the appearance of microscopic defects – delamination its surface, causing premature rupture of fetal membranes the launch stage localized focal immediate type hypersensitivity reactions and restructuring epithelial cell membranes. Neutrophil macrophage properties in this case reduced and programmed to perform a cycle of incomplete phagocytosis, which increases the synthesis of inflammatory cytokines in the area of rupture of fetal membranes. Сonclusion. Reduced activity of neutrophils increases the effect of abuse and cytokine balance in favor predictor of early spontaneous labor at 28-33 weeks of gestation. Key words: morphological changes of the fetoplacental complex, early preterm birth, expectant tactics of childbirth.

scholarly journals Single embryo transfer and multifetal pregnancy reduction: perception and attitude of women seeking assisted reproduction in Nigeria

2019 ◽  
Vol 8 (5) ◽  
pp. 1821
Author(s):  
M. E. Aziken ◽  
Osaikhuwuomwan J. A. ◽  
Iribhogbe O. I.
Keyword(s):  
Embryo Transfer ◽  
Assisted Reproduction ◽  
Multiple Pregnancy ◽  
Single Embryo Transfer ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vitro Fertilization ◽  
Multifetal Pregnancy ◽  
Multifetal Pregnancy Reduction

Background: In-vitro fertilization (IVF) is associated with increased multiple pregnancy and its attendant complications. This study evaluates the attitude and acceptance of single embryo transfer (SET) and multifetal pregnancy reduction (MFPR) by clients assessing assisted reproduction in this region.Methods: A cross sectional survey of patients selected for IVF was conducted. Information on demography, knowledge of IVF procedure and their perception, attitude and acceptability of multiple pregnancy as well as their knowledge, attitude and perception to single embryo transfer and multifetal pregnancy reduction were extracted for statistical analysis.Results: Seventy-three women participated in the study. The mean age was 39 years and mean duration of infertility was 8.6 years. Only 3 (4.1%) respondents agreed to have SET as the overwhelming majority (70) 95.9% preferred 2 or more and they felt the more number of embryo transferred the better the chances of achieving pregnancy. Similarly most respondents, 38.4% (28) did not accept MFPR. Most respondents considered age (63%) and duration of infertility (78.1%) as major influencing factor for rejecting SET. Over 75% of respondents said they will still accept multiple embryos transferred despite knowledge of the possible complications.Conclusions: While most infertile women in our sub region appear to recognize the risks with multiple pregnancy, they are less interested in SET or MFPR because they perceive more embryos transferred as a means to maximize treatment outcome. Government funding, client education and a blastocyst transfer protocol may improve acceptability as well as overall preference for less number of embryos transferred in our environment.

scholarly journals Twin pregnancy, fetal reduction and the 'all or nothing problem’

2020 ◽  
pp. medethics-2020-106938
Author(s):  
Joona Räsänen
Keyword(s):  
Moral Theory ◽  
Twin Pregnancy ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
In Vitro Fertilisation ◽  
Singleton Pregnancy ◽  
Fetal Reduction ◽  
Health Related

Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin pregnancy. I argue that in the case of a twin pregnancy, there are two intuitively plausible claims: (1) abortion is morally permissible, and (2) it is morally wrong to abort just one of the fetuses. But since we should choose morally permissible acts rather than impermissible ones, the two claims lead to another highly implausible claim: the woman ought to abort both fetuses rather than only one. Yet, this does not seem right. A plausible moral theory cannot advocate such a pro-death view. Or can it? I suggest ways to solve this problem and draw implications for each solution.

Sign in / Sign up

Export Citation Format

Share Document