A STUDY TO EVALUATE THE CLINICAL PROFILE OF MULTIPLE GESTATIONS: A HOSPITAL BASED SURVEY

Background: Monochorionic twins showed increased incidence of discordant growth as compared to dichorionic twins. Studies have reported fivefold mortality of twins in comparison with singleton pregnancy. In this a prospective study is done to assess the perinatal, neonatal mortality and morbidity in multiple gestations. Zygosity determines the degree of risk of chromosomal abnormalities in each fetus of a multiple gestation. The risk for aneuploidy in each fetus of an MZ pregnancy is the same as a singleton pregnancy, and except for rare cases of genetic discordancy, both fetuses are affected. In a DZ pregnancy, each twin has an independent risk for aneuploidy, and therefore has twice the risk of having a chromosomal abnormality compared with a singleton. Material and methods: This prospective observational study was conducted in the Department of Paediatrics Darbhanga Medical College and Hospital, Darbhanga Bihar India. The time period of the study from May 2019 to feb 2020. The total number of multiple gestation 160 include in this study. Results: Total 160 twins were studied, out of which preterm deliveries constituted 80.6% of all deliveries. Most of the mothers were between 24 to 30 year age group 70(43.8 %) followed by 18 to 24 year 55 (34.4 %) and most of them were primi 97(60.6%) and followed by gravid 2 was 54 (33.8%). Out of 160 patients 29 patient s was family history of twining in 18.1% of the study group. Assisted reproductive techniques such as clomiphene cirate,IUI and IVF were used by 19.4% of couples. Dichorinic diamniotic twins accounted for 84.4% and Dichorinic triamniotic 2.4 % of the total multiple deliveries. Normal Vaginal delivery was done for 65.6% of twins and LSCS for 34.4%. Conclusion: Most common type of delivery was vaginal delivery (65.6%) followed by LSCS (34.4%).Out of the variables studied, significant influence on neonatal mortality was seen only with discordant twins

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Age-Related Success with Elective Single versus Double Blastocyst Transfer

ISRN Obstetrics and Gynecology ◽

10.5402/2011/656204 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Brooke E. Friedman ◽

Lynn B. Davis ◽

Ruth B. Lathi ◽

Lynn M. Westphal ◽

Valerie L. Baker ◽

...

Keyword(s):

Age Groups ◽

Blastocyst Transfer ◽

Multiple Gestation ◽

Optimal Outcome ◽

Singleton Pregnancy ◽

Multiple Gestations ◽

Age Related ◽

Single Blastocyst Transfer ◽

Significant Difference ◽

Single Versus

Background. Although the optimal outcome of assisted reproductive technology (ART) is a healthy singleton pregnancy, the rate of twin gestation from ART in women over the age of 35 is persistently high. Methods/Findings. We compared clinical pregnancy rates (PRs), ongoing pregnancy/live birth rates, and multiple gestation rates (MGRs) in 108 women who chose elective single blastocyst transfer (eSBT) to 415 women who chose elective double blastocyst transfer (eDBT) at a hospital-based IVF center. There was no significant difference in PR between eSBT and eDBT (57.4% versus 50.2%, ) nor between eSBT and eDBT within each age group: <35, 35–37, 38–40, and >40. The risk of multiple gestations, however, was greatly increased between eSBT and eDBT (1.6 versus 32.4%, ), and this difference did not vary across age groups. Conclusion(s). Women undergoing eDBT are at uniformly high risk of multiple gestation regardless of age. eSBT appears to significantly lower the risk of multiple gestation without compromising PR.

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Evaluation of Maternal and Fetal Stress Hormones During the Process of Birth

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2017.753 ◽

2018 ◽

Vol 24 (2) ◽

pp. 65

Author(s):

Burcu Kisa Karakaya ◽

Ozlem Moraloglu ◽

Rahime Bedir Findik ◽

Necati Hancerliogullari ◽

Hatice Celik ◽

...

Keyword(s):

Stress Response ◽

Caesarean Section ◽

Vaginal Delivery ◽

Umbilical Cord ◽

Elective Caesarean Section ◽

Mode Of Delivery ◽

Normal Vaginal Delivery ◽

Singleton Pregnancy ◽

Beta Endorphin ◽

Tertiary Center

Objective: This study aims to determine whether mode of delivery is associated with the endocrine stress response in mother and newborn.Study Design: This prospective observational study was conducted with 86 women with a normal singleton pregnancy who delivered healthy infants between 37 and 41 weeks of gestation in a tertiary center. Study groups included; (1) women undergoing normal vaginal delivery with epidural anesthesia, (2) women undergoing vaginal delivery with immersion in water for pain relief during labor, (3) women delivered through elective caesarean section without labor. After delivery, thyroid stimulating hormone, cortisol, insulin, prolactin and Beta-endorphin levels were measured in maternal and umbilical cord serum and their relationships between modes of delivery were investigated.Results: It was found that the concentrations of cortisol and beta-endorphin after vaginal delivery with immersion in water group in both mothers and infants were higher than other two modes of delivery and these differences were statistically significant. Umbilical cord concentration of cortisol was the lowest in the caesarean section group.Conclusions: Maternal and fetal stress response was found to be associated with the mode of delivery and labor.

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Study of primary caesarean section in multigravida patients

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175843 ◽

2017 ◽

Vol 7 (1) ◽

pp. 185

Author(s):

Neelam Rajput ◽

Priyanka Singh ◽

Yogendra Singh Verma

Keyword(s):

Caesarean Section ◽

Neonatal Mortality ◽

Vaginal Delivery ◽

Low Socioeconomic Status ◽

Birth Asphyxia ◽

Fetal Distress ◽

Normal Vaginal Delivery ◽

Major Surgery ◽

Medical Disorders ◽

Number Of Patients

Background: Caesarean section is the most commonly performed major surgery among women. The aims and objective of this study was to know the incidence of primary Caesarean section in multigravidas, its indications and to know the maternal and foetal outcome among these patients.Methods: It was a prospective study of primary caesarean section in multigravida admitted at Kamla Raja Hospital, G.R. Medical College and J. A. Group of Hospitals, Gwalior (Madhya Pradesh, India) during the period of 1 year from September 2014 to August 2015. Multigravida with pregnancy of >28 weeks gestation (gravida 2 and above), each of whom has had a previous vaginal delivery of > 20 weeks gestation were included. Women with previous abortions and previous section and Pregnancy with medical disorders were excluded.Results: During the study period of one year, total 8185 deliveries occurred, out of which 3061 (37.39%) underwent caesarean section and 386 (12.61%) were primary caesarean section in multigravida. Out of these multigravida patients who underwent primary caesarean section- most of the patients were unbooked (77.72%). Majority of the cases were direct admission in the hospital (61.13%). Maximum number of the patients were in the age group of 25-30 years (55.95%). Two third of the patients were literate (69.44%) Maximum number of patients were Gravida 2 (49.72%). Almost all of them (95.85%) underwent emergency caesarean section. The most common indication for primary LSCS in multigravida patients was Malpresentation 115 (29.79%) followed by Fetal distress in 71 (18.39%) patients, APH in 71 (18.39%), Obstructed labour in 33 (8.55%), Severe preeclampsia and Antepartum eclampsia in 39 (10.1%), Twin pregnancy in 21 (5.44%). Most common maternal complication was pyrexia 40 (10.36%). Postoperative morbidity was 21.24% among unbooked, 14.25% in Referred, 23.58% in those operated as an emergency, 12.43% in patients belonging to of low socioeconomic status and 3.88%, in patients with moderate to severe anemia. Birth asphyxia was found in 6.21% of neonates. Neonatal mortality was 2.33%. Neonatal mortality is more in Unbooked cases (90.47%).Conclusions: Many unforeseen complications occur in women who previously had a normal vaginal delivery. It is recommended that all antenatal patients must be booked and receive proper and regular antenatal care. Also 100% deliveries in multigravida should be institutional deliveries in order to reduce maternal and perinatal morbidity and mortality.

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Clinical Phenotypes Associated With Preterm Births at Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu County, Kenya

International Journal of Current Aspects ◽

10.35942/ijcab.v3iiii.38 ◽

2019 ◽

Vol 3 (III) ◽

pp. 175-186

Author(s):

Edwin Omondi Juma ◽

Margaret Keraka ◽

Anthony Wanyoro

Keyword(s):

Preterm Birth ◽

Neonatal Mortality ◽

Statistical Significance ◽

Preterm Births ◽

Bivariate Analysis ◽

P Value ◽

Multiple Gestation ◽

Under Five ◽

Clinical Phenotypes ◽

Multiple Gestations

Preterm birth is a global health problem. It is the leading cause of child and neonatal mortality globally including Kenya. Preterm birth is the birth occurring before 37 completed weeks of gestation. In Kenya, preterm birth is the leading cause of neonatal mortality as it contributes to 35% of deaths among the neonates while Kisumu County is among the county’s leading with child under-five mortality rate at 133 deaths per 1000 live births. The main objective of this study was to identify the clinical phenotypes associated with preterm birth in JOOTRH in Kisumu County. It was a cross sectional study based on women who had a preterm birth alive or stillbirth at JOORTH in Kisumu County. Purposive sampling technique was used to select 178 respondents who met the inclusion criteria. Interviewer administered questionnaire was used to collect both qualitative and quantitative data. Data was analyzed by computer software SPSS version 23; descriptive statistics was used together with inferential statistics (Chi-square and Fisher’s Exact test) to help in the identification of the statistical significance of any association between the variables. A p value of < 0.05 was used. Bivariate analysis was utilized to measure the strength of associations. Data presented by use of frequency tables and narrative description. Ethical clearance was sought from Kenyatta University Ethics and Review Committee, permit sought from NACOSTI, consent and assent from the respondents. Results showed that maternal age (p=0.011) to be statistical significant with preterm births. Clinical phenotypes based on maternal, fetal and placental conditions; preeclampsia/eclampsia (p=0.016), extrauterine infections which includes malaria, UTI and HIV (p=0.030), severe maternal conditions that includes DM, anaemia, cardiac disease, hypertension prior to pregnancy and TB (p=0.001), multiple gestations (p=0.013), fetal anomaly (0.048), IUGR (p=0.049), antepartum stillbirth (p=0.046) and APH/early bleeding that include placenta previa and placenta abruption (p=0.025) were all significantly associated with preterm births. On bivariate analysis between clinical phenotypes and preterm births, all except multiple gestation (p=0.416) and APH (p=0.660) remained statistically significant. All clinical phenotypes (maternal, fetal and placental conditions) were significantly associated with preterm births. All clinical phenotypes except multiple gestations and APH/early bleeding remained statistically significant after bivariate analysis. The study recommends the use of Barro’s classifications system of clinical phenotypes to phenotype all preterm births in JOOTRH. Early identification of maternal, fetal and placental conditions identified in this study to be associated with preterm births by adopting Barros’ phenotyping of preterm births as a strategy to help prevent the occurrence of PTBs and eventually reduce neonatal deaths and under-five mortality.

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