PROGNOSIS AND PREVENTION OF OBSTETRIC AND PERINATAL COMPLICATIONS  IN MULTIPLE PREGNANCIES

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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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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P–756 Predictive factors influencing multiple live births in cumulative IVF cycles: retrospective analysis of over 265000 embryo transfer procedures from the national French registry

Human Reproduction ◽

10.1093/humrep/deab130.755 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

D Nogueira ◽

B Keppi ◽

G Regnier-Vigouroux ◽

E Scalici ◽

S Cens ◽

...

Keyword(s):

Risk Factors ◽

Decision Making ◽

Embryo Transfer ◽

Live Birth ◽

Negative Impact ◽

Oocyte Retrieval ◽

Multiple Pregnancies ◽

Perinatal Complications ◽

Fertilisation Rate ◽

Frozen Embryos

Abstract Study question What are the factors that could predict the number of embryos to be transferred in order to diminish risk of multiple pregnancies? Summary answer Single embryo transfer (SET) is advisable for <38 year-old women in fresh cycles and for <35 year-old women in FET whatever the IVF number attempts. What is known already Multiple pregnancies are associated to increased maternal and perinatal complications. Risks associated to multiple implantations are significantly reduced with SET policy. However, while SET is more assertive with a lesser negative impact in younger patients (<35 years), its feasibility is less evident for the older population, whom oocyte quality is likely compromised. A double embryo transfer (DET) could improve chances of implantation and shorten their time to pregnancy. Identification of risk factors for multiple pregnancies could help in decision making for a double or SET and reduce chances for multiple gestations without reducing the chances to achieve pregnancy. Study design, size, duration A retrospective study from the national French data registry provided and approved by the Agence de la Biomédecine was performed. A total of 196530 fresh and 68913 frozen cycles from women aged 18–43 year-old were included (2014–2017). Risk factors assessed included women’s age, number of attempts, number of oocytes, fertilization rate, embryo stage, number of embryos transferred, number of supernumerary embryos frozen. Secondary infertility, oocyte donor, oocyte freezing, PGT, freeze-all and IVM cycles were excluded. Participants/materials, setting, methods Cumulative cycles derived from 65% of ICSI, 32% of IVF and 3,2% IVF/ICSI. The distribution of patients age at oocyte retrieval was 60% < 35, 21% < 38, 11% < 40, and 8% ≥ 40 years old. Multivariable logistic regression was conducted to calculate adjusted odds ratios with 95% confidence intervals for live birth chance and multiple live birth risk associated with each risk factor. Main results and the role of chance The chances of obtaining a cumulative live birth decreases with increased patients age (OR 0.71 for 35–38 years and 0.47 for 38–40 years, p < 0.00001), with increased number of attempts (from OR 0.87 for attempt = 2 to OR 0.74 for attempt ≥ 4, p < 0.00001), and for frozen embryos transferred (OR 0.14, p < 0.00001). The chances of live birth increases with the increased number of oocytes (from OR 1.33 for 4–12 to OR 1.52 for > 18, p < 0.00001 in all cases), with a fertilisation rate >40% (OR 1.29, p < 0.00001), with blastocyst transfer (OR 1.29, p < 0.00001), with the increase on the number of frozen embryos (OR 7.37 for >1, OR 13.08 for >2, and OR 16.92 for >6, p < 0.00001 in all cases) and number of embryos transferred (OR 1.42 for 2 embryos and OR 1.39 for >2 embryos, p < 0.00001 in all cases). In case of live birth, the risks of multiple births when two embryos were transferred decreases in patients aged >38 years (OR 0.50, p < 0.00001) and for frozen embryos transferred (OR 0.65, p < 0.00001). The risk increases with a fertilisation rate >60% (OR 1.30, p < 0.00001), with blastocysts transfer (OR 1.34, p < 0.00001) and when at least one supernumerary embryo is frozen (OR > 1.30, p < 0.00001). Limitations, reasons for caution This study is limited in only providing a risk-benefit balance for multiples on the choice of transferring one or two embryos. Clinical data such as stimulation protocols and doses of gonadotropins were not considered in this evaluation. Wider implications of the findings: This study provides help to develop a strategy for the medical staff in the decision making for the number of embryos to be transferred. It may also serve as a patient’s information aid and help to improve their chances of achieving a health singleton if pregnant. Trial registration number Not applicable

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Comparison of maternal and neonatal outcome of IVF/ICSI conceived pregnancies with spontaneous conceived pregnancies

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184536 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4715

Author(s):

Preeti Patil ◽

Gayathri Karthik

Keyword(s):

Birth Weight ◽

Caesarean Section ◽

Low Birth Weight ◽

Neonatal Outcome ◽

First Trimester ◽

Multiple Pregnancies ◽

Perinatal Complications ◽

Female Ratio ◽

Spontaneous Conception ◽

Male Female Ratio

Background: Conception by IVF has been associated with an increased incidence of several obstetrical and perinatal complications. IVF is associated with increased complications like OHSS (Ovarian Hyper Stimulation Syndrome), multiple pregnancies and thromboembolism, ectopic pregnancy, congenital malformations, and small for gestational age, low birth weight etc. This study is done to evaluate and compare the obstetric and perinatal complications between assisted reproduction and spontaneous conception. The objective of the present study was to evaluate and compare the maternal and neonatal outcome of IVF/ICSI conceived pregnancies with spontaneous conceived pregnancies.Methods: In this study 62 patients conceived with IVF/ICSI were taken as cases and 62 patients conceived spontaneously were taken as controls. The categorical data was analyzed using chi square test and results expressed by p value.Results: The incidence of multiple pregnancies among IVF/ICSI group is 33.8% and 1.6% in controls. IVF/ICSI conception when compared to spontaneous conception is associated with increased incidence of miscarriage (18% versus 1.6%), first trimester bleeding (18% versus 1.6%), cervical insufficiency (22.5% versus 0), PROM (11.3% versus 1.6%), preterm birth (33.8% verss 14.5%), caesarean section rates (71% vs 53%), low birth weight babies (44% vs 10.7%) and NICU admissions(33.3% vs 10.7%). The male: female ratio is higher in IVF/ICSI group.Conclusions: IVF/ICSI conceptions are associated with a significantly higher incidence of multiple pregnancies, miscarriage, prematurity, increased caesarean section rates, and increased male: female ratio.

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Delayed interval delivery of the second and third fetuses in multiple pregnancy triplet (Сase report)

HEALTH OF WOMAN ◽

10.15574/hw.2016.111.148 ◽

2016 ◽

pp. 148-152

Author(s):

Y. Dubossarskaya ◽

◽

L. Padalko ◽

L. Zakharchenko ◽

E. Savel’eva ◽

...

Keyword(s):

Preterm Delivery ◽

Multiple Pregnancy ◽

Bed Rest ◽

Perinatal Morbidity ◽

Perinatal Complications ◽

Triplet Pregnancy ◽

Satisfactory Condition ◽

Nulliparous Women ◽

Perinatal Center ◽

Delayed Interval Delivery

This article describes a clinical case of vaginal delivery in nulliparous women 24 years old delayed interval delivery of the second and third fetuses in spontaneous multiple pregnancy dichorionic triamniotic triplet in a tertiary perinatal center. After preterm delivery in 27+5 weeks of gestation the first fetus to reduce perinatal morbidity and mortality of two fetuses that are left in the uterus, with informed consent of the woman preterm delivery the second and third fetuses occurred at intervals of 38 days, in 33+1 weeks of gestation. Careful monitoring of the state of the mother and fetuses was conducted. To increase the interval between the birth of the first fetus and the second and the third fetuses, prevention of obstetric and perinatal complications used tocolysis, antibiotics, progesterone, the prevention of respiratory distress syndrome of the newborn by corticosteroids and bed rest. Three girls were born alive with a weight of 980, 1800 and 1950 grams correspondingly. Childbirth complicated second degree perineal laceration and retained portions of placenta and membranes, puerperal period was uneventful. After 1.5 months, all infants discharged with her mother in a satisfactory condition with a weight of more than 3000 grams. Key words: multiple pregnancy, triplet pregnancy, delayed interval delivery in triplet pregnancy, preterm delivery.

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1387-P: Risk of Perinatal Complications across Gestational Blood Pressure Levels in Women with and without Gestational Diabetes (GDM)

Diabetes ◽

10.2337/db20-1387-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1387-P

Author(s):

YEYI ZHU ◽

JUANRAN FENG ◽

AMANDA NGO ◽

CHARLES QUESENBERRY ◽

ASSIAMIRA FERRARA

Keyword(s):

Blood Pressure ◽

Gestational Diabetes ◽

Perinatal Complications

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Prevention of Preterm Birth

Journal of Biomedical and Clinical Research ◽

10.2478/jbcr-2018-0013 ◽

2018 ◽

Vol 11 (2) ◽

pp. 95-104

Author(s):

Ivan D. Ivanov ◽

Stefan A. Buzalov ◽

Nadezhda H. Hinkova

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

High Risk ◽

Medical Science ◽

Secondary Prophylaxis ◽

High Risk Group ◽

Screening Methods ◽

Perinatal Complications ◽

Social Significance ◽

Neonatal Deaths

Summary Preterm birth (PTB) is a worldwide problem with great social significance because it is a leading cause of perinatal complications and perinatal mortality. PTB is responsible for more than a half of neonatal deaths. The rate of preterm delivery varies between 5-18% worldwide and has not decreased in recent years, regardless of the development of medical science. One of the leading causes for that is the failure to identify the high-risk group in prenatal care. PTB is a heterogeneous syndrome in which many different factors interfere at different levels of the pathogenesis of the initiation of delivery, finally resulting in delivery before 37 weeks of gestation (wg). The various specificities of risk factors and the unclear mechanism of initiation of labour make it difficult to elaborate standard, unified and effective screening to diagnose pregnant women at high-risk for PTB correctly. Furthermore, they make primary and secondary prophylaxis less effective and render diagnostic and therapeutic measures ineffective and inappropriate. Reliable and accessible screening methods are necessary for antenatal care, and risk factors for PTB should be studied and clarified in search of useful tools to solve issues of risk pregnancies to decrease PTB rates and associated complications.

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