Features of functional maturation of the central nervous system in fetuses with multiple pregnancies

The study was undertaken to detect some peculiarities of fetal rest activity cycle formation in multiple pregnancy. 86 fetuses (43 twins) were observed with the following assessment of the newbornsneurological status. The rest activity cycle parameters and haemodynamic indices of fetoplacental system were examined. Also there was considered the influence of IUGR and twins birth weight discordance on CNSfunctionalformation. The results showed that twins comparing with single pregnancies are characterized by the retardation of rest activity cycle formation that is manifested in shortening оf the quite and prolongation оf the intermediate states, lowering of cardiac rhythm variability and motorcardial reflex. These findings substantiate the necessity of including twins into high-risk group concerning neurological disorders in the newborns. The IUGR appears an additional factor increasing this risk.

Deep Infiltrating Endometriosis and Adenomyosis: Implications on Pregnancy and Outcome

Endometriosis (EM), especially deep infiltrating endometriosis (DIE) and adenomyosis (AM), are known to cause pain and sterility in young women. More recently, they have also been described as risk factors for obstetric complications. While the pathophysiology is not yet completely understood, they seem to share a common origin: archimetrosis. Methods: A systematic literature review was conducted to summarize the existing evidence on DIE and AM as risk factors for obstetric complications. Results: Preterm birth, caesarean section delivery (CS) and placental abnormalities are associated with the diagnosis of DIE and AM. Women with AM seem to experience more often hypertensive pregnancy disorders, premature rupture of membranes and their children are born with lower birth weights than in the control groups. However, many of the studies tried to evaluate AM, EM and DIE as separate risk factors. Moreover, often they did not adjust for important confounders such as multiple pregnancies, parity, mode of conception and maternal age. Therefore, prospective studies with larger numbers of cases and appropriate adjustment for confounders are needed to explore the pathophysiology and to prove causality.

Trends of Selective Fetal Reduction and Selective Termination in Multiple Pregnancy, in England and Wales: a Cross-Sectional Study

Selective abortion was shown to be increasingly common in England and Wales over a 9-year period, occurring most frequently as twin to singleton reductions in the 1st trimester. We analysed the trends in selective abortion (SA) in multiple pregnancies in England and Wales between 2009 and 2018. This is a cross-sectional study looking at 1143 women with multiple pregnancies in England and Wales undergoing SA. There were a total of 1143 cases of SA between 2009 and 2018 in England and Wales, representing 0.07% of total abortions. There has been a steady increase in cases, from 90 in 2009 to 131 in 2018, with 82.3% justified under ground E of The Abortion Act 1967. The majority of SAs were carried out at 13–19 weeks gestation, and intracardiac injection of potassium chloride was the most prevalent method (75%). Twin to singleton reductions accounted for 59%, the most common form of SAs. Over half of all cases (59%) were performed in women aged 30–39 years, and 84% of all women were of White ethnicity. SA has been an option available for couples diagnosed with multiple pregnancy, especially when there are discordant anomalies. Although SA may decrease multiple pregnancy-related complications, preventative methods must be championed.

Analysis of factors associated with early neonatal deaths through linkage between SIM and SINASC, in Sergipe, Brazil

In Brazil, more than 70% of neonatal deaths are concentrated in the early neonatal period, with about 41.2% of them occurring in the first 24 hours of life. Thus, the objective of this study was to carry out an analysis of factors associated with early neonatal deaths that occurred in Sergipe, Brazil, through the linkage of records in the information systems: Live Birth Information System (SINASC) and Mortality Information System (SIM). This study was carried out in Sergipe, Brazil, in which an analysis was made of secondary data on children born and early neonatal deaths in Sergipe between 2006 and 2019 registered in the SINASC and in the SIM. A linkage was carried out between the databases, identifying 484,629 live births, 480,784 survivors and 3,845 who died with less than 7 days of life, with a low percentage of ignored data or absent. Maternal age was similar between groups. However, the newborns who died had lower weight, gestational age and Apgar in the first and fifth minutes than the survivor group. Regarding the newborn, there were more deaths in males and in congenital malformations. As for information about the mother and pregnancy, there were more deaths in single women, multiple pregnancies, lower gestational ages and vaginal delivery. There was an association between neonatal deaths and lower Apgar in the first and fifth minutes, lower weights, lower gestational ages, male gender, congenital malformations, women with multiple pregnancies, vaginal births and single mothers.

Twins with Craniosynostosis: An Unidentified Variant/Twin Research: Kangaroo Care for Premature Twins; Developmental Delay in MZ Twins; Osteosarcoma in One Identical Twin; Controversies in Twin Pregnancy Management/Media Reports: Twin and Triplet Olympians; Twin’s Rescue from a Crocodile; Twin Pandas in Japan; Twin Surrogacy; Identical Twins in Pennsylvania

Craniosynostosis involves the early closure of one or more joints connecting the bones of an infant’s skull. A case of young monozygotic (MZ) male twins with an unidentified variant of this condition is described, followed by a summary of relevant published reports. This overview is followed by descriptions of a kangaroo care program for premature twins, developmental delay in an MZ twin pair, osteosarcoma in one MZ twin and controversial issues in the management of multiple pregnancies. Media reports of twin and triplet Olympic athletes, a twin’s rescue from a crocodile, the birth of twin pandas in Japan, a case of twin surrogacy and the birth of identical triplets are also presented.

Outcome of prenatal diagnosis of clubfoot: a single institution experience

Aim: To assess the accuracy of antenatal diagnosis of clubfoot (CF), risk factors and outcomes in postnatal. Patients & methods: Maternal characteristics, sonographic signs and postnatal outcomes were evaluated in 60 patients with a prenatal diagnosis of CF between 2007 and 2020. Results: The rate of antenatal diagnosis of CF was 3.72/1000 live births. The false-positive rate was 6.67%. 66.7% of fetuses had bilateral CF and 33.3% had unilateral CF; 58.3% were isolated and 41.7% were complex; 58.3% were males and 41.7% were female; 16.7% were multiple pregnancies and 10% were cases of consanguinity. Conclusion: The accuracy of the diagnosis of CF depends on the operator’s skills. A significant relationship is demonstrated between the interruption of pregnancy, consanguinity, laterality and complexity.

Selective termination of the fetus in multiple pregnancies using ultrasound-guided radiofrequency ablation

Background To evaluate the perinatal outcomes in women with selective termination using ultrasound-guided radiofrequency ablation (RFA). Methods Complicated monochorionic (MC) twin pregnancies and multiple pregnancies with an indication for selective termination by ultrasound-guided coagulation of the umbilical cord with RFA under local anesthesia between July 2013 and Jan 2020 were reviewed. We analyzed the indications, gestational age at the time of the procedure, cycles of RFA, duration of the procedure, and perinatal outcome. Results Three hundred and thirteen patients were treated during this period. Seven of whom were lost of follow-up. The remaining 306 cases, including 266 pairs of monochorionic diamniotic (MCDA) twins (86.93%), two pairs of monoamniotic twins (0.65%), 30 dichorionic triamniotic (DCTA) triplets (1%), and three monochorionic triamniotic (MCTA) triplets (0.98%), were analyzed. Indications included twin-to-twin transfusion syndrome (TTTS) (n = 91), selective fetal growth restriction (sFGR) (n = 83), severe discordant structural malformation (n = 78), multifetal pregnancy reduction (MFPR) (n = 78), twin reverse arterial perfusion sequence (TRAPS) (n = 19), and twin anemia-polycythemia sequence (TAPS) (n = 3). Upon comparison of RFA performed before and after 20 weeks, the co-twin loss rate (20.9% vs. 21.5%), the incidence of preterm premature rupture of membranes (PPROM) within 24 h (1.5% vs. 1.2%), and the median gestational age at delivery [35.93 (28–38) weeks vs. 36 (28.54–38.14) weeks] were similar (p > 0.05). Conclusions RFA is a reasonable option when indicated in multiple pregnancies and complicated monochorionic pregnancies. In our experience, the overall survival rate was 78.76% with RFA in selective feticide, and early treatment increases the likelihood of survival for the remaining fetus because the fetal loss rate is similar before and after 20 weeks.

Impact of COVID-19 Lockdown on Preterm Births, Low Birthweights and Stillbirths: A Retrospective Cohort Study

Objective: The effect of lockdowns during the coronavirus (COVID-19) pandemic on pregnancy outcomes remains uncertain. We aimed to evaluate the association between the COVID-19-related lockdown and pregnancy outcomes in maternity hospitals in France. Study design: This was a retrospective cohort study from six tertiary referral hospitals in different regions of France. Three 55-day periods were compared: pre-lockdown from 22 January 2020, lockdown from 17 March 2020, and post-lockdown from 11 May 2020 to 4 July 2020. We included all women who delivered singleton or multiple pregnancies, who delivered at ≥24 weeks of gestation and with birthweights ≥500 g. We documented gestational ages at the delivery of liveborn and stillborn infants (‘stillbirths’). These were categorized as having a very low birthweight (VLBW, <1500 g), or a low birthweight (LBW, <2500 g). Adjustments were made for place of birth, maternal age, parity and diabetes, and hypertensive disorders, as well as for multiple pregnancies. Results: In total, 11,929 women delivered in the six selected centers. This figure is constituted of 4093, 3829, and 4007 deliveries in the pre-lockdown (1), peri-lockdown (2), and post-lockdown (3) periods, respectively. There were no differences in pregnancy outcomes between these three periods. Overall, birth rates <27+6 weeks, between weeks 28+0 and 31+6, and between 32+0 and weeks 36+6 were 1.0%, 1.9%, and 4.4%, respectively. After adjustment, these rates were stable between periods 1 and 2 (adjusted odds ratio, aOR 0.90; 95% confidence interval, CI 0.69–1.19) and between periods 2 and 3 (aOR 1.04; 95% CI 0.80–1.36). Although more VLBW neonates were born during lockdown (3.5% vs. 2.6%, p = 0.03), this difference did not persist after adjustment (aOR 0.84, CI 95% 0.64–1.10). The LBW rates were similar during the three periods at 12.5% overall. The stillbirth rate was unaffected by the lockdown. Conclusion: The pregnancy outcomes (preterm birth, LBW, VLBW, and stillbirth rates) were not modified by the COVID-19 lockdown in our cohort study in France. Considering the discrepancies in results and methodological issues in previous published studies, there is not sufficient evidence to conclude that such lockdowns have any impact on perinatal outcomes.

Risks and challenges in multiple pregnancy

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.