The predictors of preterm labour in patients with multiple pregnancy

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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All the right moves: why in utero transfer is both important for the baby and difficult to achieve and new strategies for change

F1000Research ◽

10.12688/f1000research.25923.1 ◽

2020 ◽

Vol 9 ◽

pp. 979

Author(s):

Helena Watson ◽

James McLaren ◽

Naomi Carlisle ◽

Nandiran Ratnavel ◽

Tim Watts ◽

...

Keyword(s):

Preterm Birth ◽

Transfer Process ◽

Assisted Reproductive Technologies ◽

Clinical Care ◽

Multiple Pregnancy ◽

Reproductive Technologies ◽

In Utero ◽

The Uk ◽

The Right ◽

The Impact

The best way to ensure that preterm infants benefit from relevant neonatal expertise as soon as they are born is to transfer the mother and baby to an appropriately specialised neonatal facility before birth (“in utero”). This review explores the evidence surrounding the importance of being born in the right unit, the advantages of in utero transfers compared to ex utero transfers, and how to accurately assess which women are at most risk of delivering early and the challenges of in utero transfers. Accurate identification of the women most at risk of preterm birth is key to prioritising who to transfer antenatally, but the administrative burden and pathway variation of in utero transfer in the UK are likely to compromise optimal clinical care. Women reported the impact that in utero transfers have on them, including the emotional and financial burdens of being transferred and the anxiety surrounding domestic and logistical concerns related to being away from home. The final section of the review explores new approaches to reforming the in utero transfer process, including learning from outside the UK and changing policy and guidelines. Examples of collaborative regional guidance include the recent Pan-London guidance on in utero transfers. Reforming the transfer process can also be aided through technology, such as utilising the CotFinder app. In utero transfer is an unavoidable aspect of maternity and neonatal care, and the burden will increase if preterm birth rates continue to rise in association with increased rates of multiple pregnancy, advancing maternal age, assisted reproductive technologies, and obstetric interventions. As funding and capacity pressures on health services increase because of the COVID-19 pandemic, better prioritisation and sustained multi-disciplinary commitment are essential to maximise better outcomes for babies born too soon.

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Perinatal outcomes of pregnancies conceived by assisted reproductive technologies

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1510632s ◽

2015 ◽

Vol 143 (9-10) ◽

pp. 632-638 ◽

Cited By ~ 2

Author(s):

Tamara Sljivancanin ◽

Olivera Kontic-Vucinic

Keyword(s):

Preterm Birth ◽

Perinatal Mortality ◽

Very Low Birth Weight ◽

Assisted Reproductive Technologies ◽

Perinatal Outcomes ◽

Reproductive Technologies ◽

Perinatal Complications ◽

Very Preterm ◽

Very Preterm Birth ◽

Significant Difference

Introduction. Recent epidemiological studies showed significantly higher incidence of perinatal complications in newborns and women after the use of assisted reproductive technologies (ART). Multiple pregnancies are more frequent after the use of ART. Singleton pregnancies following ART are more prone to preterm birth, low and very low birth weight (LBW and VLBW), small for gestational age (SGA) and perinatal mortality. Objective. The aim of this study was to summarize the results of relevant articles and to evaluate whether the mode of conception is the determining factor for different pregnancy outcomes after assisted and natural conceptions. Methods. Eleven studies were included in this review. The following outcomes were observed: preterm and very preterm birth, SGA, LBW, VLBW, perinatal mortality, admission to neonatal intensive care unit (NICU), and Apgar score (As) ?7 at fifth minute. Qualitative analysis and quantitative assessment were performed. Results. For singletons, odds ratios were 1.794 (95% confidence interval 1.660-1.939) for preterm birth, 1.649 (1.301-2.089) for LBW, 1.265 (1.048-1.527) for SGA. Admission to NICU, As?7 at fifth minute and perinatal mortality showed significantly different frequency after assisted conception. Summary of results for twin gestations showed no significant difference between ART and spontaneous conception for preterm birth (32-36 weeks), very preterm birth (<32 weeks), LBW and VLBW. Conclusion. Analyzed studies showed that infants from ART have significantly worse perinatal outcome compared with natural conception. More observational studies should be conducted in order to establish the exact mechanism leading to more frequent perinatal morbidity and mortality after the use of ART.

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The influence of assisted reproductive technologies on obstetric and perinatal outcomes: the chicken, the egg, or both?

Fertility and Sterility ◽

10.1016/j.fertnstert.2021.01.022 ◽

2021 ◽

Vol 115 (4) ◽

pp. 884-885

Author(s):

Luis R. Hoyos ◽

Steven J. Ory

Keyword(s):

Assisted Reproductive Technologies ◽

Perinatal Outcomes ◽

Reproductive Technologies

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Clinical and statistical analysis of obstetrics and perinatal complications in singleton and multiple pregnancy after assisted reproductive technology

HEALTH OF WOMAN ◽

10.15574/hw.2020.153.67 ◽

2018 ◽

pp. 67-73

Author(s):

T.G. Romanenko ◽

◽

O.M. Sulimenko ◽

S.O. Ovcharenko ◽

◽

...

Keyword(s):

Statistical Analysis ◽

Fetal Growth ◽

Growth Retardation ◽

Assisted Reproductive Technologies ◽

Multiple Pregnancy ◽

Fetal Distress ◽

Reproductive Technologies ◽

Fetal Growth Retardation ◽

Multiple Pregnancies ◽

Perinatal Complications

The objective: conduct a comparative clinical and statistical analysis of obstetric and perinatal complications in singleton and multiple pregnancies after assisted reproductive technologies (ART) according to archival documents (pregnancy observation data and birth history) and identify features of multiple pregnancy. Materials and methods. During the period 2017–2019, 522 women gave birth in maternity hospital «Leleka» after assisted reproductive technologies, 331 women were observed in the maternity hospital «Leleka». 445 women gave birth with a singleton pregnancy and 77 with a multiple pregnancy. A clinical and statistical analysis of 150 pregnancy and childbirth histories was performed. All pregnant women were divided into two groups: Group I – 75 pregnant women with singleton pregnancies after ART; Group II – 75 pregnant women with multiple pregnancies after ART. The selection criteria for comparative clinical and statistical analysis were women whose pregnancies occurred as a result of ART, namely by in vitro fertilization (IVF) using five-day frozen embryos. Mathematical research methods were performed in accordance with the recommendations of O.P. Minzer (2013). The reliability of the cancellation of the mean pairs was calculated using the Student’s and Fisher’s criteria. Graphs were designed using the program «Microsoft Excel». Results. Complications of early pregnancy in multiple pregnancies were: anemia (47.8% vs. 22.9%; p<0.01), placental dysfunction (43.3% vs. 22.9%; p<0.01), the threat of abortion (41.8% vs. 28.6%; p<0.01). Complications of the second half of pregnancy: preeclampsia (52.7% vs. 20.6%; p<0.01), fetal growth retardation (20.0% vs. 7.4%; p<0.01), gestational anemia (76,4% vs. 32.4%; p<0.01), placental dysfunction (47.3% vs. 22.1%; p<0.05). Complications in childbirth in women with multiple pregnancies were as follows: premature rupture of membranes (30.9% vs. 10.3%; p<0.05), anomalies of labor activity (16.4% vs. 5.9%; p>0.05), fetal distress (29.1% vs. 14.7%; p<0.05), premature placental abruption (3.6% vs. the absence of this indicator in group I). In patients of group II with multiple pregnancies 3.7 times more often the pregnancy ended prematurely compared with singleton (21.8% vs. 5.9%; p<0.05). Early preterm births predominated, of which births occurred in 3.6% of cases at 22–28 weeks, 7.3% at 28–32 weeks, and 6.4% at 32–34 weeks. Significant increase in the frequency of 32.7% of abdominal births in multiple pregnancies against 11.8% of patients in pregnancy with a single fetus (p<0.01). The structure of indications in patients of group II was as follows: severe preeclampsia 27.8%, development of fetal growth retardation and fetal distress of 11.1%, respectively, premature placental abruption 16.7%, the following single indications (pelvic presentation of the fetus, transverse or oblique position of the fetus, clinically narrow pelvis, abnormalities of labor, scar on the uterus) – 33.3%. Significant increase in the total frequency of neonatal asphyxia of varying severity in multiple pregnancies (35.0% vs. 5.9%; p<0.05), fetal growth retardation (27.3% vs. 11.8%; p<0.01). Conclusions. Multiple pregnancies are a high risk factor for gestational anemia, preeclampsia, placental dysfunction, early fetal growth retardation, and fetal distress during pregnancy and childbirth. This causes a high level of abdominal delivery. Therefore, further research to predict and prevent obstetric and perinatal complications in multiple pregnancies after ART is relevant today. Keywords: obstetric and perinatal complications of pregnancy, multiple pregnancy, assisted reproductive technologies.

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Iatrogenic Multiple Pregnancy and Assisted Reproductive Technologies

Principles and Practice of Assisted Reproductive Technology (3 Volumes) ◽

10.5005/jp/books/12151_68 ◽

2014 ◽

pp. 770-770

Author(s):

Veronica Yuel

Keyword(s):

Assisted Reproductive Technologies ◽

Multiple Pregnancy ◽

Reproductive Technologies

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581: Are perinatal outcomes different in triplets conceived spontaneously as compared to those by assisted reproductive technologies?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2015.10.626 ◽

2016 ◽

Vol 214 (1) ◽

pp. S312

Author(s):

Tania Roman ◽

Oscar A. Viteri ◽

Alejandra Ontiveros ◽

Ziad A. Haidar ◽

Sean C. Blackwell ◽

...

Keyword(s):

Assisted Reproductive Technologies ◽

Perinatal Outcomes ◽

Reproductive Technologies

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Iatrogenic multiple birth, multiple pregnancy and assisted reproductive technologies

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(98)00230-6 ◽

1999 ◽

Vol 64 (1) ◽

pp. 11-25 ◽

Cited By ~ 36

Author(s):

L Keith ◽

J.J Oleszczuk

Keyword(s):

Assisted Reproductive Technologies ◽

Multiple Pregnancy ◽

Reproductive Technologies ◽

Multiple Birth

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Effectiveness and outcomes of embryo cryopreservation programs in assisted reproductive technologies

Journal of obstetrics and women s diseases ◽

10.17816/jowd63439-46 ◽

2014 ◽

Vol 63 (4) ◽

pp. 39-46 ◽

Cited By ~ 1

Author(s):

Yana Nikolayevna Kravchuk ◽

Alla Stanislavovna Kalugina ◽

Olga Vladimirovna Bystrova ◽

Svetlana Aleksandrovna Shlykova

Keyword(s):

Embryo Transfer ◽

Assisted Reproductive Technologies ◽

Negative Impact ◽

Perinatal Outcomes ◽

Reproductive Technologies ◽

Embryo Cryopreservation ◽

Control Group ◽

Fresh Embryo Transfer ◽

Art Programs ◽

Thawed Embryo Transfer

Background. Embryo cryopreservation is an essential part of ART programs today. In recent years vitrification method is used increasingly widely. Purposes and tasks. To compare the effectiveness of ART programs using vitrified and fresh embryos, as well as different endometrial preparation regimes for frozen\thawed embryo transfer (modified natural cycle (MNC) and the preparatory hormone therapy(PHT)). To analyze the course of pregnancy and perinatal outcomes after vitrified embryo transfer. Materials and methods. We prospectively assessed the ART programs effectiveness and perinatal outcomes in 153 patients (I group), who underwent vitrified embryo transfer in 2011-2013 year. To prepare the endometrium for thawed embryo transfer in 83 patients PHT (Ia subgroup) and MNC in 70 patients (Ib subgroup) were used. Control group consisted of 70 patients, who underwent fresh embryo transfer. Results. The clinical pregnancy rate, birth rate and “take home baby” rate were not significantly different between the I (47,5 %; 30,9 %; 30,9 %) and II (53,0 %; 34,9 %; 32,5 %) groups, and between Ia (48,3 %; 28,4 %; 28,4 %) and IIb (46,6 %; 34,1 %; 34,1 %) subgroups. Complications during pregnancy and delivery, birthweight, length, Apgar score, congenital malformation rate did not differ significantly after vitrified and fresh embryo transfer. Conclusion. Vitrification is an effective method to achieve clinical results, comparable to native cycles. Application of PHT and MNC results in similar clinical outcomes. Transfer Vitrified embryo transfer does not have a negative impact on obstetric and perinatal outcomes when compared with native cycles.

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