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Objective: The main risk factor for preterm delivery (PTD; <37 gestational weeks) is having a history of PTD. The aim of this research was to compare the risk for recurrent PTD following twin versus singleton gestation PTD. Methods: A retrospective population‐based cohort study was performed, including all women who had two consecutive pregnancies, the first of which ended with PTD. The incidence of PTD recurrence was compared between women with PTD in twin versus singleton gestation. Multivariable logistic models were used to study the association between twinning status and PTD recurrence, and specifically by gestational age of the first PTD, inter‐pregnancy interval (IPI), and mode of conception. Results: The study population included 15 590 women, of whom 1680 (10.8%) had twins in their index pregnancy and 13 910 (89.2%) had singletons. The incidence of recurrent PTD was 10.5% (n = 177) following twin PTD versus 21.9% (n = 3044) following singleton PTD (adjusted odds ratio = 0.50, 95% confidence interval 0.32–0.76, while controlling for confounding variables). The results were consistent while stratifying by IPI, gestational age of the first PTD, or mode of conception. Conclusions: Women with PTD in twin gestations are at lower risk for recurrent PTD compared with women with singleton PTD. Women with preterm delivery (PTD) in twin versus singleton gestations are at lower risk for recurrent PTD, regardless of gestational age, inter‐pregnancy interval or conception mode. [ABSTRACT FROM AUTHOR]

Abstract Aim To conduct a comparative analysis of risk factors for retinopathy of prematurity (ROP) in single- and multiple-born neonates. Methods In a retrospective evaluation of 521 premature neonates, encompassing singletons, twins, and triplets born at or before 34 weeks of gestational age with a birthweight of less than 2000 g and who completed the ROP screening program, between 2020 and 2023, in outpatient referral ROP screening clinic affiliated by Shiraz University of Medical Sciences, were included. Neonates with the eligibility criteria were enrolled in the screening program from 28 days old age and followed up to discharge or treatment based on national ROP screening guideline. Data on ROP severity, outcome, treatment modality, and risk factors, including gestational age (GA), birth weight (BW), sex, duration of neonatal intensive care unit (NICU) admission, oxygen supplementation, mechanical ventilation, blood transfusion, method of delivery, and maternal and neonatal comorbidities, were extracted and compared between premature neonates from singleton and multiple births. Results The analysis of the ROP severity distribution revealed 238 neonates (45.7%) with low-risk (type 2 prethreshold ROP or less severe) ROP and 16 (3.1%) with high-risk (type I prethreshold ROP or more severe) ROP who underwent treatment. According to the comparative analysis of risk factors in neonates with ROP requiring treatment, multiple birth neonates exhibited significantly greater GA (27.50 ± 3.27 vs. 30.00 ± 2.00 vs. 31.14 ± 0.38 weeks, p = 0.032 for singletons, twins and triplets, respectively); greater BW (861.67 ± 274.62 vs. 1233.33 ± 347.75 vs. 1537.14 ± 208.86 g, p = 0.002); and shorter duration of NICU admission (60.17 ± 21.36 vs. 34.00 ± 12.17 vs. 12.00 ± 6.32 days, p = 0.001) and oxygen supplementation (47.33 ± 16.57 vs. 36.00 ± 8.49 vs. 4.60 ± 2.41 days, p = 0.001). There was no significant difference between single-born neonates and multiple-born neonates regarding the prevalence of other risk factors. Multiple-born neonates with no ROP and low risk ROP showed significantly lower GA and BW compared to singletons (p

Objective: To assess whether the risk for future diabetes is higher among women diagnosed with gestational diabetes (GD) during twin versus singleton gestations. Method: A retrospective cohort study was performed including all women who delivered at a tertiary medical center between the years 1991 and 2021 and had at least one GD diagnosis. The first GD diagnosis per women was defined as the index pregnancy. Women diagnosed with GD during multiple gestations were compared with women diagnosed with GD during singleton gestations. The outcomes included first hemoglobin A1C (Hba1C) level > 6.4 mg/dL post partum, and the highest level measured during the follow‐up period of up to 30 years. Multivariable logistic and Cox proportional analysis were used to compare the risk between the two groups while adjusting for confounding variables. Results: The current study included 13 770 mothers, with 458 patients (3.3%) diagnosed with GD during twin gestations and 13 312 (96.7%) during singleton gestations. The mean follow‐up was 12.25 ± 9.3 years. Mothers of both groups did not differ in age at index pregnancy; however, mothers of twins were more likely to conceive following fertility treatments. Incidence of diabetes and prediabetes (defined as Hba1C > 6.4 and >5.7, respectively) were lower among the twin‐gestation group, both during the 6‐month postpartum period (for diabetes: 15.5% vs 22.1%; odds ratio [OR], 0.65 [95% confidence interval (CI), 0.46–0.91]) and during the long‐term follow‐up (for diabetes: 31.8% vs 40.7%; OR, 0.68 [95% CI, 0.52–0.88]). These results remained significant in the multivariable analysis, while accounting for age, ethnicity, and fertility treatments. Conclusion: GD diagnosis during multiple versus singleton gestations is associated with a lower risk for future diabetes. Synopsis: Women diagnosed with gestational diabetes during twin gestation are at lower risk for future diabetes, suggesting that gestational diabetes criteria should account for multiple gestation. [ABSTRACT FROM AUTHOR]

Objectives: The association between pregestational diabetes mellitus (PDM) and risk of congenital heart disease (CHD) is well recognized; however, the importance of glycemic control and other coexisting risk factors during pregnancy is less clear. We sought to determine the relative risk (RR) of major CHD (mCHD) among offspring from pregnancies complicated by PDM and the effect of first‐trimester glycemic control on mCHD risk. Methods: We determined the incidence of mCHD (requiring surgery within 1 year of birth or resulting in pregnancy termination or fetal demise) among registered births in Alberta, Canada. Linkage of diabetes status, maximum hemoglobin A1c (HbA1c) at < 16 weeks' gestation and other covariates was performed using data from the Alberta Perinatal Health Program registry. Risk of mCHD according to HbA1c was estimated as an adjusted RR (aRR), calculated using log‐binomial modeling. Results: Of 1412 cases of mCHD in 594 773 (2.37/1000) births in the study period, mCHD was present in 48/7497 with PDM (6.4/1000; RR, 2.8 (95% CI, 2.1–3.7); P < 0.0001). In the entire cohort, increased maternal age (aRR, 1.03 (95% CI, 1.02–1.04); P < 0.0001) and multiple gestation (aRR, 1.37 (95% CI, 1.1–1.8); P = 0.02) were also associated with mCHD risk, whereas maternal prepregnancy weight > 91 kg was not. The stratified risk for mCHD associated with HbA1c ≤ 6.1%, > 6.1–8.0% and > 8.0% was 4.2/1000, 6.8/1000 and 17.1/1000 PDM/gestational diabetes mellitus births, respectively; the aRR of mCHD associated with PDM and HbA1c > 8.0% was 8.5 (95% CI, 5.0–14.4) compared to those without diabetes and 5.5 (95% CI, 1.6–19.4) compared to PDM with normal HbA1c (≤ 6.1%). Conclusions: PDM is associated with a RR of 2.8 for mCHD, increasing to 8.5 in those with HbA1c > 8%. These data should facilitate refinement of referral indications for high‐risk pregnancy screening. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Jiang and Li. Click here to view the Correspondence. [ABSTRACT FROM AUTHOR]

Objective Obstetric studies often report neonatal morbidity as a composite score. Composite scores can simplify data analysis when multiple outcomes of interest are present and allows researchers to conduct smaller, more manageable trials. The Hassan scale is a neonatal morbidity composite scale that assigns high scores to infants with multiple morbidities and low scores to infants without or with single morbidities. The objective of this study was to validate the association between scores on the Hassan scale and neonatal intensive care unit (NICU) length of stay Study Design We conducted a cohort study of all infants born between 22 and 36 6/7 weeks' gestation and cared for within 419 neonatal units in the Pediatrix Medical Group between 1997 and 2018. Each infant was assigned a Hassan's score based on the number of neonatal morbidity events that occurred during the delivery hospitalization. The association between Hassan's scores and neonatal length of stay was evaluated using linear regression. Multivariable models were constructed to determine if the Hassan score was independently associated with neonatal length of stay. Results There were 760,037 infants included. The median (interquartile range [IQR]) gestational age of delivery was 34 (31, 35) weeks and the median (IQR) birth weight at delivery was 2,000 (1,503, 2,430) g. The median length of stay for infants discharged home was 17 (10–33) days. A Hassan's score was able to be assigned to 699,206 (92%) patients. Neonatal morbidities included in the Hassan scale were more common among infants born earlier in gestation. On adjusted analysis, the Hassan scale was found to be independently associated with neonatal length of stay (p < 0.001, coefficient = 10.4 days [95% confidence interval (CI): 10.3, 10.4 days]) with higher scores associated with longer lengths of stay. Conclusion The Hassan scale, more than a binary composite score, is able to differentiate preterm infants with prolonged hospitalizations from those with short hospitalizations. Key Points The Hassan scale is an independent predictor of neonatal length of stay. Classification of infants based on number of morbidities correlates with neonatal length of stay. The Hassan scale provided better discrimination than binary composite morbidity scores. The Hassan scale may be an economic predictor of health-related costs. [ABSTRACT FROM AUTHOR]

Objective  The objective of the study was to review the obstetric outcomes of complete hydatidiform molar pregnancies with a coexisting fetus (CHMCF), a rare clinical entity that is not well described. Materials and Methods  We performed a retrospective case series with pathology-confirmed HMCF. The cases were collected via solicitation through a private maternal-fetal medicine physician group on social media. Each contributing institution from across the United States ( n  = 9) obtained written informed consent from the patients directly, obtained institutional data transfer agreements as required, and transmitted the data using a Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant modality. Data collected included maternal, fetal/genetic, placental, and delivery characteristics. For descriptive analysis, continuous variables were reported as median with standard deviation and range. Results  Nine institutions contributed to the 14 cases collected. Nine (64%) cases of CHMCF were a product of assisted reproductive technology and one case was trizygotic. The median gestational age at diagnosis was 12 weeks and 2 days (9 weeks-19 weeks and 4 days), and over half were diagnosed in the first trimester. The median human chorionic gonadotropin (hCG) at diagnosis was 355,494 mIU/mL (49,770-700,486 mIU/mL). Placental mass size universally enlarged over the surveillance period. When invasive testing was performed, insufficient sample or no growth was noted in 40% of the sampled cases. Antenatal complications occurred in all delivered patients, with postpartum hemorrhage (71%) and hypertensive disorders of pregnancy (29%) being the most frequent outcomes. Delivery outcomes were variable. Four patients developed gestational trophoblastic neoplasia. Conclusion  This series is the largest report of obstetric outcomes for CHMCF to date and highlights the need to counsel patients about the severe maternal and fetal complications in continuing pregnancies, including progression to gestational trophoblastic neoplastic disease. Key Points CHMCF is a rare obstetric complication and may be associated with the use of assisted reproductive technology.Universally, patients with CHMCF who elected to manage expectantly developed antenatal complications.The risk of developing gestational trophoblastic neoplasia after CHMCF is high, and termination of the pregnancy did not decrease this risk.

Twin gestations are at increased risk of single intrauterine fetal death. A first-trimester loss is a common complication in twin gestations. The rate of co-twin morbidity and mortality is higher when a single demise occurs in the second and third trimesters. Monochorionicity strongly influences the prognosis for the surviving co-twin. Fetal ultrasound combined with MRI may be able to help predict neurological injury to the surviving co-twin. The rate of co-twin demise decreases with advancing gestation. After single intrauterine fetal demise, monochorionic gestations should be delivered by 34 weeks and dichorionic by 36 to 37 weeks gestation. [ABSTRACT FROM AUTHOR]

Compared with singleton pregnancies, triplet pregnancies are associated with a significantly increased risk of adverse pregnancy outcomes. Early ultrasound examination is the best way to diagnose triplets, establish dating, and determine the number of placentas to provide appropriate counseling and monitoring. Dichorionic placentation adds risks specifically associated with a shared placenta, and limits options for intervention. Multifetal reduction is an option that can significantly improve pregnancy outcomes compared with non-reduced triplet pregnancies. Integration of a Maternal-Fetal Medicine specialist in the prenatal care for a triplet pregnancy reduces the risk of preeclampsia, preterm birth, low birthweight infants, perinatal mortality, and major neonatal morbidity. [ABSTRACT FROM AUTHOR]

All patients with twin pregnancy should have first trimester ultrasound and be offered screening for chromosomal aneuploidy as well as diagnostic testing. Screening for aneuploidy in twins presents unique challenges compared with singletons. Cell-free DNA screening should be considered first-line; however, this option may not be available or may have limitations in certain clinical scenarios, such as vanishing twins. If cell-free DNA screening is not available, maternal serum marker screening in conjunction with nuchal translucency assessment should be offered. Patients with positive aneuploidy screening tests or fetal structural abnormalities should be offered diagnostic testing. [ABSTRACT FROM AUTHOR]

Introduction: Multiple gestations are a risk factor for most pregnancy complications. The current study aimed to study whether offspring born after twin pregnancies are at increased risk for long‐term health complications. Material and methods: A retrospective cohort study was conducted in a large medical center, including all offspring born between the years 1991–2021, which were followed‐up until 18 years of age. Hospital‐based diagnoses of the offspring were categorized into main groups of morbidities: cardiac, respiratory, infectious, neurological, malignancy, and metabolic. Incidence of hospitalization with diagnoses from each main group was compared between twins and singletons, as well as time to first hospitalization. Cox proportional hazard models were used to study the association between twins vs singletons and hospitalizations by grouped morbidities, while adjusting for maternal age, ethnicity and gender, besides maternal recurrence in the cohort. Results: A total of 369 478 offspring were included in the analysis; of these 11 986 (3.2%) were twins and 357 492 (96.8%) were singletons. Twins were more likely to be delivered preterm (odds ratio = 17.65, 95% CI: 16.74–18.60), by cesarean delivery and following infertility treatments. Incidence of hospitalizations with all morbidity groups was slightly, some significantly, higher among twins, including cardiac: 1.9% vs 1.5%, respiratory; 8.4% vs 7.1%, neurological: 7.7% vs 7.4%, infectious: 26.0% vs 24.1%, and malignancies: 0.7% vs 0.4%. The risk remained higher in the multivariable analyses (adjusted hazard ratios ranging between 1.09–1.75). When stratifying by gestational age at delivery, the risk for most morbidities was lower among twins vs singletons born in similar gestational ages. Conclusions: Twins as compared to singletons are at increased risk for most morbidities due to their risk of being born earlier. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of respiratory allergy on obstetrics and perinatal outcomes. Methods: A nested case–control retrospective study on 41 035 pregnant women. Obstetrics and perinatal outcomes of women with or without respiratory allergy were compared. Rates of preterm delivery (<37 weeks of gestation), low birth weight (<2500 g), neonatal acidosis (pH < 7.20), low 5‐min APGAR score (<7), cesarean section rate and indications, and perinatal morbidity and mortality were analyzed. Results are expressed as number and percentages. χ2 and Fisher exact tests were used for comparisons. Logistic regression was used. Statistical significance was set at 95% level (P < 0.05). Results: A total of 724 (1.8%) patients had respiratory allergy, and their rates of preterm delivery and low birth weight were significantly higher than those of control women (both P < 0.001). Nevertheless, analyzing the causes, multiple gestation rate was significantly higher in this group, and adjusting by this, no statistical difference was found in any of the perinatal outcomes studied. In addition, in vitro fertilization and sterility were also significantly higher in the respiratory allergy group (both P < 0.001). Conclusion: Women with respiratory allergy are at higher risks of prematurity and low birth weight but these results are mediated by sterility, in vitro fertilization, and multiple gestation rate. Nonetheless, participation of inflammatory mechanisms should be further studied. Synopsis: Women with respiratory allergies are at higher risk of prematurity and low birth weight, but these results are mediated by sterility, IVF, and multiple gestation rate. [ABSTRACT FROM AUTHOR]

PURPOSE:To evaluate whether cerclage in twins reduces the rate of spontaneous preterm birth

BackgroundDespite improvements in fetal survival for pregnancies affected by twin-twin transfusion syndrome since the introduction of laser photocoagulation, prematurity remains a major source of neonatal morbidity and mortality.ObjectiveTo investigate the indications and factors influencing the timing of delivery following laser treatment, we collected delivery information regarding twin-twin transfusion syndrome cases in a large multicenter cohort.Study designEleven North American Fetal Therapy Network (NAFTNet) centers conducted a retrospective review of twin-twin transfusion syndrome patients who underwent laser photocoagulation. Clinical, demographic and ultrasound variables including twin-twin transfusion syndrome stage, and gestational age at treatment and delivery were recorded. Primary and secondary maternal and fetal indications for delivery were identified. Univariate analysis was used to select candidate variables with significant correlation with latency and GA at delivery. Multivariable Cox regression with competing risk analysis was utilized to determine the independent associations.ResultsA total of 847 pregnancies were analyzed. After laser, the average latency to delivery was 10.11 ± 4.8 weeks and the mean gestational age at delivery was 30.7 ± 4.5 weeks. Primary maternal indications for delivery comprised 79% of cases. The leading indications included spontaneous labor (46.8%), premature rupture of membranes (17.1%), and placental abruption (8.4%). Primary fetal indications accounted for 21% of cases and the most frequent indications included donor non-reassuring status (20.5%), abnormal donor Dopplers (15.1%), and donor growth restriction (14.5%). The most common secondary indications for delivery were premature rupture of membranes, spontaneous labor and donor growth restriction. Multivariate modeling found gestational age at diagnosis, stage, history of prior amnioreduction, cerclage, interwin membrane disruption, procedure complications and chorioamniotic membrane separation as predictors for both gestational age at delivery and latency.ConclusionPremature delivery after laser therapy for twin-twin transfusion syndrome is primarily due to spontaneous labor, preterm premature rupture of membranes and non-reassuring status of the donor fetus. Placental abruption was found to be a frequent complication resulting in early delivery. Future research should be directed toward the goal of prolonging gestation after laser photocoagulation to further reduce morbidity and mortality associated with twin-twin transfusion syndrome.

• In women with PCOS, multiple gestation increases the risk of preterm delivery 8-fold. • Multiple gestation increases the risk of pre-eclampsia 2.9-fold in women with PCOS. • Women with PCOS and multiple gestation are at increased risk of gestational diabetes. • In women with PCOS, multiple gestation increases the risk of Caesarean delivery 5-fold. • Neonates born to mothers with PCOS and multiple gestation are more likely to be SGA. Research question: Does multiple gestation alter the risks for adverse obstetric outcomes in women with polycystic ovary syndrome (PCOS)? Design: Retrospective population-based cohort study using data from the HCUP-NIS from 2004 to 2014. A total of 14,882 women with PCOS, who delivered within that time period, were identified. The study group comprised women with PCOS who had had a multiple gestation (n = 880); the reference group was comprised of the remaining women with PCOS and singleton gestation (n = 14,002). Results: In women with PCOS, multiple gestation increased the risks of pregnancy complications including pregnancy-induced hypertension (adjusted odds ratio [aOR] 2.030; 95% confidence interval [CI] 1.676–2.460), pre-eclampsia (aOR 2.879; 95% CI 2.277–3.639), pre-eclampsia and eclampsia superimposed on pre-existing hypertension (aOR 1.917; 95% CI 1.266–2.903) and gestational diabetes (aOR 1.358; 95% CI 1.114–1.656). Multiple gestation increases the risk of preterm premature rupture of membranes (aOR 5.807; 95% CI 4.153–8.119), preterm delivery (aOR 8.466; 95% CI 7.071–10.135), Caesarean section (aOR 5.146; 95% CI 4.184–6.329), post-partum haemorrhage (aOR 1.540; 95% CI 1.065–2.228) and the need for transfusion (aOR 3.268; 95% CI 2.010–5.314), as well as wound complications (aOR 3.089; 95% CI 1.647–5.794). Neonates born to mothers with PCOS and having multiple gestations are more likely to be small for gestational age when compared to singleton neonates born to mothers with PCOS (aOR 4.606; 95% CI 3.480–6.095). Among PCOS women with multiple gestations, obesity increased the risks of developing pregnancy-induced hypertension (P < 0.001), pre-eclampsia (P < 0.001) and wound complications (P = 0.045). Conclusion: These results highlight the importance of single embryo transfer and ovulation induction to develop a single follicle in women with PCOS. Obesity further increases obstetrical complications. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to examine the association between the risk of preterm delivery among women with twin pregnancies and their obstetric history. Study Design We designed a retrospective cohort study of live twin births in 2008 in the United States that delivered after 24 0/7 weeks. Women were categorized into nulliparas, multiparas with prior term delivery, and multiparas with prior preterm delivery. The incidence of preterm birth was compared using Chi-square test and multivariable logistic regression models. Results A total of 32,895 nulliparous and 64,701 multiparous women with twin pregnancies were included in the study. Of the multiparous women, 2,505 (4%) had a history of a prior preterm delivery. Multiparous women with prior term birth were more likely to deliver at term (43%) in the index twin pregnancy than nulliparous women (40%) and multiparous women with a prior preterm birth (21%; p < 0.001). Compared with nulliparous women, prior term birth was protective against preterm delivery (adjusted odds ratio [aOR] = 0.67 [95% confidence interval: 0.60–0.74] for delivery <28 weeks and aOR = 0.79 [0.71–0.77] for delivery <34 weeks). Conclusion Among multiparous women with twins, a prior term delivery appeared to be protective against preterm delivery compared with nulliparous women with twins. Key Points Prior term birth is protective against preterm birth in subsequent twin pregnancy. A prior term birth confers an OR of 0.66 for delivery prior to 28 weeks in twin pregnancies. A prior preterm birth renders a twin pregnancy nearly twice as likely to deliver before 28 weeks. [ABSTRACT FROM AUTHOR]

Objective: Adverse pregnancy outcomes (APOs) and early menopause are each associated with increased risk of cardiovascular disease (CVD); whether APOs are associated with age at menopause is unclear. We examined the association of gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preterm birth, and multiple gestation with age at natural menopause.Study Design: Observational, prospective study within the Nurses' Health Study II cohort (1989-2019).Main Outcomes Measures: Risk of early natural menopause, defined as occurring before the age of 45 years, and age at onset of natural menopause (hazard ratio (HR) >1 indicates younger age at menopause).Results: The mean [SD] baseline age of 69,880 parous participants was 34.5 [4.7] years. Compared with participants who had a term singleton first birth, those with a term multiple-gestation first birth had higher risk of early menopause (HR: 1.65, 95% CI: 1.05, 2.60) and younger age at natural menopause (HR: 1.46, 95% CI: 1.31, 1.63). Estimates for preterm multiple gestation were of similar magnitude. Menopause occurred at a younger age for those with a preterm birth with spontaneous labor (HR: 1.08, 95% CI: 1.03, 1.14) compared to those with a term birth with spontaneous labor. Conversely, estimates for GDM (HR: 0.95, 95% CI: 0.89, 1.02) and HDP (preeclampsia, HR: 0.93, 95% CI: 0.89, 0.97) suggested an association with older age at menopause.Conclusions: In this large cohort study, several statistically significant associations between APOs and age at natural menopause were observed. A deeper understanding of the relationships among APOs, menopause, and CVD is needed to help identify people at higher risk for early menopause and later CVD. [ABSTRACT FROM AUTHOR]

Objective There is a lack of consensus about the management of twins with significant cervical length (CL) shortening, especially if CL is above 25 mm. Therefore, it is important to define “abnormal” CL change over time, and to compare the performance of different strategies. The aim of this study was twofold, to describe the performance of the cervical shortening and that of an integrated strategy that includes both the cervical shortening and a fixed CL cutoff <25 mm in any measurement as predictor of spontaneous PTB (sPTB) < 34 weeks in uncomplicated twin pregnancies. Material and methods Retrospective cohort study of twins followed in our Twins Clinic at Hospital Italiano de Buenos Aires from 2013 to 2017. Inclusion criteria were dichorionic or monochorionic diamniotic twins with CL measurement between 18 and 33 + 6 weeks with available data of the delivery. Exclusion criteria included any of the following complications: iatrogenic preterm delivery <34 weeks, cerclage, fetal growth restriction, fetal death, structural anomalies, polyhydramnios, twin–twin transfusion syndrome, selective fetal growth restriction, twin anemia–polycythemia sequence, and twin reversed arterial perfusion sequence. Spontaneous preterm birth was defined as spontaneous delivery <34 weeks. Cervical shortening was analyzed in the following periods: 20–24 weeks, 20–28 weeks, 24–28 weeks, 24–32 weeks and 28–32 weeks. Cervical changes were analyzed as velocity of shortening over time (mm/week) and as the ratio of shortening over time (%/week). ROC curves for each period were constructed and two different cutoffs were used to classify changes of the CL as positive or negative screening: a) the shortening of CL associated to the highest value of the Youden Index and b) fixing a 10% false positive rate (FPR). For the second objective, we analyzed an integrated strategy considering a fixed cutoff of 25 mm at any GA and/or a significant shortening. The screening was considered positive if any CL measurement was <25 mm at any GA or there was a shortening of the CL ≥ the cutoff obtained for each period. We report sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio and area under the ROC curve. Results We included 378 patients and 1417 measurements, 284 (75%) dichorionic and 94 (25%) monochorionic. Between 20 and 28 weeks, with a change in CL cutoff = 1.6 mm/week or 4.1%/week the detection rate was 54.2% (32.8–74.4%) and the specificity 80.5% (75.1–85.1%) and 83.5% (78.5–87.8%) respectively. In the integrated strategy, the detection rate was 65.7% (47.8–80.9%) and the specificity 69 (63.7–74). All the ROC curves of the periods studied showed an AUC < 0.7. In the group of patients that delivered preterm the initial mean CL was shorter than in the term group, 39 (±12) mm vs. 43 (± 7.7) mm (p = .02) and the most important change in CL was at 20–24 weeks both in the velocity and in the ratio of shortening over time. Conversely, patients that delivered at term showed a higher change in CL in the third trimester. Conclusion The performance of all the strategies analyzed as a predictor of sPTB <34 weeks was moderate. The period 20–28 weeks detected half of the patients at risk with a FPR around 10–20% and the integrated strategy increased the sensitivity up to a detection of two thirds of the patients at risk but with a FPR of ∼30%. Future analyses need to explore other strategies to improve the performance and to really identify the patients at higher risk. [ABSTRACT FROM AUTHOR]

Objective: To examine the outcomes of twins and singletons in the late preterm period. Materials and methods: This is a retrospective cohort study of data obtained for 165,894 births in California who delivered between 34 þ 0 and 36þ 6 weeks. The primary outcome was neonatal and infant mortality. The secondary outcomes included the following neonatal morbidities: respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), seizure, and sepsis. Univariate analysis was performed using chi-square test and multivariable logistic regression was used to adjust for potential confounders. Results: There were 143,891 singleton and 22,003 twin gestations included in the study. There was no difference in the primary outcome, neonatal and infant mortality between twins and singletons delivered at 34 and 36 weeks. After controlling for multiple potential confounders, significant differences in secondary outcomes of neonatal morbidity were identified. At 34 weeks, twins had significantly higher rates of IVH (aOR 2.47 (95%CI 1.08–5.64)), NEC (aOR 2.46 (95%CI 1.42–4.29)), RDS (aOR 1.60 (95%CI 1.45–1.77)), and sepsis (aOR 1.19 (95%CI 1.05–1.34)) compared to singletons. By 36 weeks, only an increased risk of RDS persisted among twins. Conclusions: While there was no difference in mortality among twins and singletons in the late preterm period, twins may have significantly increased neonatal morbidity compared to singletons delivered between 34þ 0 and 36 þ 6 weeks. [ABSTRACT FROM AUTHOR]

Objective: Multiple gestation increases the risk of unscheduled preterm birth (PTB), both spontaneous and indicated, leading to increased neonatal morbidity and additional healthcare costs. The purpose of this study was to determine whether cervical length (CL) assessment by 28 weeks could predict unscheduled PTB <34 weeks in triplet pregnancies. Secondary outcomes included prediction of PTB <30 weeks, prediction of PTB based on degree of cervical change and effect of ART-use on PTB. Methods: This was a retrospective cohort of women with triplet pregnancies. The exposure variable of interest was short cervix < 25 and <20 millimeters (mm) by 28 weeks. Maternal characteristics were described. The distribution of CLs was analyzed by the primary outcome of unscheduled PTB < 34 weeks, and by PTB <30 weeks (secondary outcome). Gestational age at delivery was compared between women with and without a short cervix. Changes in CL were compared between the groups with unscheduled PTB and those delivering ≥34 and ≥30 weeks. Statistical analyses were performed using appropriate tests. Results: Of 92 triplet pregnancies, 51 met the criteria, with 1233 total (411 shortest) CL measurements from 16 to 34 weeks' gestation. The overall rate of PTB <34 weeks was 31.4% and <30 weeks was 9.8%. The median gestational age at delivery was 32.7 (IQR 2.3) weeks. There were no statistically significant differences in rates of unscheduled PTB in women who had a short cervix and those that did not: PTB <34 weeks with CL <25mm (p=.53) and CL <20mm (p=.70); PTB <30 weeks with CL <25mm (p=.38) and CL <20mm (p=.26). The degree of cervical change from 18 to 28 weeks was not statistically significant for predicting unscheduled PTB <34 and <30 weeks. Of 70.6% of triplet pregnancies conceived by ARTs, 13.9% had unscheduled PTB <30 weeks, whereas no spontaneously-conceived pregnancies delivered <30 weeks (p=.14). Conclusion: Short cervix did not predict unscheduled spontaneous PTB <34 weeks nor <30 weeks in our triplet cohort, nor did the degree of cervical change by 28 weeks predict PTB. Triplets conceived by ARTs may have an increased risk of unscheduled PTB. [ABSTRACT FROM AUTHOR]

While cervical length (CL) provides an effective screening tool for spontaneous preterm birth in singletons, the performance in twins is still controversial. Our aim was twofold. First, to compare the performance of a single CL measurement at mid-gestation (∼20 weeks) versus serial measurements as a predictor of spontaneous preterm birth < 34 weeks in uncomplicated twin pregnancies. Second, to describe the performance of a single CL at ∼24, ∼28 and ∼32 weeks. cohort study of twins followed at Hospital Italiano de Buenos Aires from 2013 to 2017. Inclusion criteria were dichorionic or monochorionic diamniotic twins with CL measurement between 18 and 33 + 6 weeks with available data of the delivery. Exclusion criteria included any of the following complications: iatrogenic preterm delivery <34 weeks, cerclage, fetal growth restriction, fetal death, structural anomalies, polyhydramnios, twin–twin transfusion syndrome, selective fetal growth restriction, twin anemia–polycythemia sequence, and twin reversed arterial perfusion sequence. Spontaneous preterm birth was defined as spontaneous delivery < 34 weeks. Two different cutoffs were used to classify CL as short (positive screening) or normal (negative screening): (a) a fixed cutoff of 25 mm at any gestational age (GA). The screening was considered positive if any CL measurement was <25 mm; and (b) a GA adjusted cutoff to a 10% false positive rate (FPR). The 10% FPR for each GA was calculated and the screening was considered positive if any of the CL measurements were below this 10% FPR cutoff. We report sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio and area under the ROC curve. Among 777 twins followed in our Unit, 381 met exclusion criteria and 18 were excluded due to incomplete follow-up. We included 378 patients, 284 (75%) dichorionic and 94 (25%) monochorionic. The performance of one CL at 20 weeks showed a sensitivity ≤ 20% with an area under the ROC curve of 0.58 (95% CI, 0.45–0.70), while the performance of serial measurements showed a sensitivity of 58.8% (95% CI, 40.7–75.4) with an area under the ROC curve of 0.70 (95% CI, 0.61–0.79) (p <.001). The analyses of the performance of a single CL at ∼24, ∼28 and ∼32 weeks showed similar AUC than the serial measurements and, for a FPR = 10%, the performance of one measurement at 24 and 32 weeks showed a sensitivity of 30% (95% CI, 14.7–49.4) and 31.6% (95% CI, (12.6–56.6), while the measurement at 28 weeks showed a sensitivity of 48.3% (95% CI, (29.4–67.5). Serial measurements showed a better performance than a single one in mid-gestation. Moreover, among single measurements the CL in mid-gestation showed the poorest performance, while the 28 weeks assessment detected half of the preterm deliveries. However, all the strategies showed modest performances. [ABSTRACT FROM AUTHOR]

Abstract Background Multiple gestations are associated with an increased incidence of preeclampsia. However, there exists no evidence for an association between multiple gestations and development of hypertension(HTN) later in life. This study aimed to determine whether multiple gestations are associated with HTN beyond the peripartum period. Methods In this retrospective nationwide population-based study, women who delivered a baby between January 1, 2007, and December 31, 2008, and underwent a national health screening examination within one year prior to their pregnancy were included. Subsequently, we tracked the occurrence of HTN during follow-up until December 31, 2015, using International Classification of Diseases-10th Revision codes. Results Among 362,821 women who gave birth during the study period, 4,944 (1.36%) women had multiple gestations. The cumulative incidence of HTN was higher in multiple gestations group compared with singleton group (5.95% vs. 3.78%, p

Abstract Background Multiple gestation has been on the rise because of advancement in assisted reproductive technology. Triplet pregnancy is associated with fetal loss and preterm birth as its major complications. Spontaneous triplet pregnancy is rare. In the case of fetal loss, delayed interval delivery has been used to achieve delivery of the retained fetuses. There is no common approach to delayed interval delivery. Case A 31-year-old East African lady with spontaneous triplet pregnancy presented to our institution at gestation age of 19 weeks with features of threatened miscarriage. One fetus was miscarried, and delayed interval delivery was done as an outpatient. At gestation age of 35 weeks, she delivered healthy twins by cesarean section. Conclusion Delayed interval delivery improves neonatal outcomes of high-order pregnancy after fetal loss even in a resource-limited setting.

Background: It remained controversial whether women with multiple gestation are at higher risk of placenta accreta spectrum (PAS) disorders and large-scale studies are needed. This study aimed to assess whether PAS incidence is higher among women with multiple gestation than among singleton, as well as to compare the characteristics and outcomes of PAS in multiple and singleton gestation. Methods: Women who underwent cesarean section with live births at Peking University First Hospital from January 2015 to December 2020 were included. Demographic and clinical information was collected through chart review. Logistic regression models were used to analyze the associations between multiple gestation and PAS. The clinical characteristics and perioperative outcomes of PAS in multiple and singleton gestation were further compared. Results: Among the 14583 women included, 2.4% (352/14583) were diagnosed with PAS. PAS was slightly more prevalent among multiple gestations than among singletons (2.5% vs 2.4%, P =0.857). After adjusting for known risk factors and pregnancy complications, multiple gestation was associated with a higher risk of PAS (a OR =1.63, 95% CI 1.01-2.62). Among PAS patients, women who had multiple births had a significantly lower rate of previous cesarean deliveries (27.6% vs. 56.3%, P =0.003), placenta previa (17.2% vs. 56.3%, P <0.001) and invasive PAS (24.1% vs. 53.9, P =0.002) than singletons. There were no significant differences in perioperative outcomes between these two groups. Conclusion: Multiple gestation could be independently associated with an elevated risk of PAS. The clinical characteristics of PAS in the multiple and singleton gestation groups differed significantly in cesarean delivery history and placenta previa. The results of this study may inform guidelines on the screening, early detection and timely intervention of PAS patients among women with multiple births. [ABSTRACT FROM AUTHOR]

Background: As the number of older women attempting to conceive through donor oocyte-in vitro fertilization (DO-IVF) rises, their safety in pregnancy needs to be judiciously considered. Aims: This study aims to review the obstetric and perinatal outcomes of pregnancies achieved by DO-IVF. Study Setting and Design: A retrospective study design conducted at a private health facility with services for assisted reproduction and gynecologic endoscopy. Methods: A retrospective comparative study of all pregnancies achieved using DO-IVF and that using Self oocyte In-vitro fertilization (SO-IVF) treatment over a 3 years' period was performed. Statistical Analysis: Comparative analysis of demographic variables, major obstetric, and perinatal complications was done with Chi-square test and Student's t-test as appropriate. Regression analysis was done to determine a significant predictor variable for pregnancy and delivery outcome. The significance level was set at P < 0.05. Results: A total of 343 completed IVF treatment cycles was reviewed; there were 238 DO-IVF and 105 SO-IVF cycles, with clinical pregnancy rate of 41.6% and 37.1%, respectively. The DO-IVF group was significantly older than the SO-IVF group (46.1 years vs. 34.1 years, P < 0.001). Major obstetric complications identified, were hypertensive disorders in pregnancy (23.9%), preterm labor (16.7%), antepartum hemorrhage (11.6%). There was no statistically significant difference between the two groups in terms of obstetric complications and adverse maternal or perinatal outcomes. There were 97 (77.6%) singleton and 28 (22.4%) multiple pregnancies. Pregnancy complications were significantly associated with fetal plurality, P < 0.001. Multiple pregnancy had higher odds of experiencing adverse perinatal 4.96 (1.95–12.58) and maternal 7.16 (2.05–25.03) outcomes compared to singleton pregnancies, P < 0.001. Conclusion: Key obstetric outcomes did not differ between DO or SO IVF achieved pregnancy. Even for older women, satisfactory outcomes can be expected for pregnancies achieved by DO-IVF. It is, however, instructive that for multiple pregnancies, obstetricians should institute appropriate surveillance strategies during pregnancy and delivery period and also to develop institutional capacity for quality neonatal care.

BackgroundIt remained controversial whether women with multiple gestation are at higher risk of placenta accreta spectrum (PAS) disorders and large-scale studies are needed. This study aimed to assess whether PAS incidence is higher among women with multiple gestation than among singleton, as well as to compare the characteristics and outcomes of PAS in multiple and singleton gestation.MethodsWomen who underwent cesarean section with live births at Peking University First Hospital from January 2015 to December 2020 were included. Demographic and clinical information was collected through chart review. Logistic regression models were used to analyze the associations between multiple gestation and PAS. The clinical characteristics and perioperative outcomes of PAS in multiple and singleton gestation were further compared.ResultsAmong the 14583 women included, 2.4% (352/14583) were diagnosed with PAS. PAS was slightly more prevalent among multiple gestations than among singletons (2.5% vs 2.4%, P=0.857). After adjusting for known risk factors and pregnancy complications, multiple gestation was associated with a higher risk of PAS (aOR=1.63, 95% CI 1.01-2.62). Among PAS patients, women who had multiple births had a significantly lower rate of previous cesarean deliveries (27.6% vs. 56.3%, P=0.003), placenta previa (17.2% vs. 56.3%, P

BACKGROUND: Preterm birth complicates almost all triplet pregnancies and no preventive strategy has proven effective. OBJECTIVE: To determine, using individual patient data (IPD) meta-analysis, whether the outcome of triplet pregnancy is affected by prophylactic administration of 17-hydroxyprogesterone caproate (17OHPc). SEARCH STRATEGY: We searched literature databases, trial registries and references in published articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) of progestogens versus control that included women with triplet pregnancies. DATA COLLECTION AND ANALYSIS: Investigators from identified RCTs collaborated on the protocol and contributed their IPD. The primary outcome was a composite measure of adverse perinatal outcome. The secondary outcome was the rate of birth before 32 weeks of gestation. Other pre-specified outcomes included randomisation-to-delivery interval and rates of birth at

Background: The Institute of Medicine (IOM) has provisional gestational weight gain (GWG) guidelines for women pregnant with twins due to limited data in this population. To better inform guidelines, the objective of this systematic review was to build on prior work and examine recent data on the associations of GWG with maternal and child health in twin pregnancies. Materials and Methods: In February 2021, Ovid MEDLINE, Embase, CINAHL, and Cochrane Library were searched. Observational studies were eligible if published from January 1, 2013 through February 23, 2021, and examined associations of GWG with maternal or child health outcomes after accounting for gestational age at delivery and pre-pregnancy body mass index. Heterogeneity across studies precluded the use of meta-analytic methods. Results: A total of 29 studies were included. For maternal outcomes, excessive GWG was associated with an increased risk of hypertensive disorders of pregnancy; whereas studies examining gestational diabetes and delivery method reported mixed findings. For child outcomes, inadequate GWG was associated with lower birthweight, small for gestational age, and preterm birth. Adequate or excessive GWG was associated with later gestational age at delivery. Conclusions: This study advances an earlier review by including a more diverse array of maternal and child outcomes. Many of the limitations noted in the original review persist; for example, no studies examined the associations of GWG and outcomes beyond birth. Although it appears that GWG within the IOM guidelines is associated with more optimal outcomes, additional methodologically rigorous studies are needed to better inform evidence-based guidelines. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the influence of advanced maternal age on the maternal and neonatal outcomes of preterm pregnancies. Material and methods: The characteristics of patients admitted to the Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University between January 2015 and March, 2019 were retrospectively reviewed. The maternal and neonatal outcomes were compared between advanced maternal age group (≥ 35 years) and younger age group (18-34 years). Statistical analysis was performed by applying the SPSS software. Results: The study population consisted of 986 pregnancies with preterm delivery and 1094 liveborn preterm infants. Multivariate analyses demonstrated that mothers of advanced age were more likely to suffer iatrogenic preterm birth, placenta previa, preeclampsia, gestational diabetes mellitus and postpartum hemorrhage, but less likely to suffer multiple gestation. In terms of neonatal outcomes, advanced maternal age was associated with a decreased rate of low birthweight in an adjusted model without multiple gestation. However, with multiple gestation included in the adjusted model, advanced maternal age was only associated with an increased rate of hyperbilirubinemia. Conclusions: Advanced maternal age was a risk factor for adverse pregnancy outcomes including iatrogenic preterm birth, placenta previa, preeclampsia, gestational diabetes mellitus, postpartum hemorrhage, and a protective factor for multiple gestation. Regarding neonatal outcomes, advanced maternal age was related to a decreased rate of low birthweight or an increased rate of hyperbilirubinemia depending on the adjustment for multiple gestation. [ABSTRACT FROM AUTHOR]

Background: Multiple gestation is simultaneous development of more than one fetus in uterus.Multiple pregnancies are associated with significantly higher fetal morbidity and mortality, maternal morbidity and associated health care costs. Materials and methods: Prospective study of the patients with multiple gestation admitted to labour room, in the Department of Obstetrics and Gynaecology, VIMS, Ballari, a tertiary health care centre, for a period of 1 year. Results: During the period of 1 year, 65 cases were analyzed. During the period 62 were twins, 2 triplets and 1 quadruplets were reported. Incidence of multiple gestation at VIMS is 0.9%. Majority of the women were of younger age group of 21-25 years, accounting for 58.4%. And most of them were primiparas accounting to 40%. 52.3% of them had preterm labor and 40% had pre eclampsia. Anemia, premature rupture of membranes and PPH were other complications. Birth weight of majority of neonates was between 1500 ± 2000gm accounting for 41%. Some of the fetal complication were less, discordant twins were 13.8%, TRAP accounted for 1 twin gestation (rare). Hyaline membrane disease is the most common cause for neonatal mortality accounting 79.41% of neonatal deaths. Conclusion: The risks of multiple pregnancies are significant. Proper management of multiple gestation at a tertiary care hospital with good obstetric and NICU facilities can reduce the complications such as HMD/RDS and improve the neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: The study aims to analyze the pregnancy outcomes of multiple gestations with preterm premature rupture of membranes (PPROM) that occurred within 24 h after fetal reduction with potassium chloride (KCL). Materials and methods: We identified and evaluated the outcomes of 16 retrospectively recorded multigestational pregnancies that met the inclusion criteria between 2006 and 2016, from the Obstetrics Department of Shandong Provincial Hospital. A total of 16 patients carrying twins or higher order multiple gestations experienced PPROM within 24 h after fetal reduction, and all of them received expectant management after understanding the relevant risks. The maternal and neonatal records were retrospectively collected and reviewed. Every surviving child was followed up to at least 2 years old. Result: Of the 16 cases, 12 cases (75%) ended in successful pregnancy, resulting in the delivery of at least 1 child surviving from a multiple gestational pregnancy. All cases of successful pregnancies were either term (≥37 weeks) or near-term (36+5 weeks) at delivery. And of those 20 infants delivered, only 3 were low birth weight infants (

Abstract Background Twin pregnancy is associated with increased perinatal mortality. Close foetal monitoring is therefore warranted. Doppler Ultrasound cardiotocography is currently the only available method to monitor both individual foetuses. Unfortunately, the performance measures of this method are poor and erroneous monitoring of the same twin with both transducers may occur, leaving the second twin unmonitored. In this study we aimed to determine the feasibility of monitoring both foetuses simultaneously in twin gestation by means of non-invasive foetal electrocardiography (NI-fECG), using an electrode patch on the maternal abdomen. Methods A NI-fECG recording was performed at 25 + 3 weeks of gestation on a multiparous woman pregnant with dichorionic diamniotic twins. An electrode patch consisting of eight adhesive electrodes was applied on the maternal abdomen, yielding six channels of bipolar electrophysiological measurements. The output was digitized and stored for offline processing. The recorded signals were preprocessed by suppression of high-frequency noise, baseline wander, and powerline interference. Secondly, the maternal ECG was subtracted and segmentation into individual ECG complexes was performed. Finally, ensemble averaging of these individual ECG complexes was performed to suppress interferences. Results Six different recordings were obtained from each of the six recording channels. Depending on the orientation and distance of the fetal heart with respect to each electrode, a distinction could be made between each fetus based on the morphology of the signals. Yielding of the fetal ECGs was performed manually based on the QRS complexes of each fetus. Conclusion NI-fECG with multiple electrodes allows for monitoring of the fetal heart rate and ECG of both individual fetuses in twin pregnancies.

Abstract Objective The objective of the study was to review the obstetric outcomes of complete hydatidiform molar pregnancies with a coexisting fetus (CHMCF), a rare clinical entity that is not well described. Materials and Methods We performed a retrospective case series with pathology-confirmed HMCF. The cases were collected via solicitation through a private maternal-fetal medicine physician group on social media. Each contributing institution from across the United States (n = 9) obtained written informed consent from the patients directly, obtained institutional data transfer agreements as required, and transmitted the data using a Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant modality. Data collected included maternal, fetal/genetic, placental, and delivery characteristics. For descriptive analysis, continuous variables were reported as median with standard deviation and range. Results Nine institutions contributed to the 14 cases collected. Nine (64%) cases of CHMCF were a product of assisted reproductive technology and one case was trizygotic. The median gestational age at diagnosis was 12 weeks and 2 days (9 weeks–19 weeks and 4 days), and over half were diagnosed in the first trimester. The median human chorionic gonadotropin (hCG) at diagnosis was 355,494 mIU/mL (49,770–700,486 mIU/mL). Placental mass size universally enlarged over the surveillance period. When invasive testing was performed, insufficient sample or no growth was noted in 40% of the sampled cases. Antenatal complications occurred in all delivered patients, with postpartum hemorrhage (71%) and hypertensive disorders of pregnancy (29%) being the most frequent outcomes. Delivery outcomes were variable. Four patients developed gestational trophoblastic neoplasia. Conclusion This series is the largest report of obstetric outcomes for CHMCF to date and highlights the need to counsel patients about the severe maternal and fetal complications in continuing pregnancies, including progression to gestational trophoblastic neoplastic disease. Key Points CHMCF is a rare obstetric complication and may be associated with the use of assisted reproductive technology. Universally, patients with CHMCF who elected to manage expectantly developed antenatal complications. The risk of developing gestational trophoblastic neoplasia after CHMCF is high, and termination of the pregnancy did not decrease this risk.

To identify the factors predicting intrauterine balloon tamponade (IUBT) failure for severe postpartum hemorrhage (PPH) after delivery, we conducted a retrospective cohort study of women who underwent IUBT for severe PPH after delivery from October 1, 2016 until September 30, 2017. The failure of IUBT was defined as the need of additional surgical procedures or uterine embolization. A total of 99,650 deliveries occurred during the study period. Among the patients, 106 cases of severe PPH were managed with IUBT, and the global success rate was 70.8% (75/106). Least absolute shrinkage and selection operator (LASSO) regression was performed to select the potential risk factors predicting IUBT failure. The associated risk factors—obesity, multiple gestation, cesarean delivery, estimated blood loss (EBL), and placenta accreta spectrum (PAS)—were included in multivariate logistic models. Ultimately, these models identified multiple gestation, EBL, and PAS as independent risk factors for IUBT failure. In conclusion, IUBT is an effective method for severe PPH. The presence of factors affecting IUBT failure should be recognized early, and other modalities of management should be anticipated.

Background: Multiple gestations are associated with an increased incidence of preeclampsia. However, there exists no evidence for an association between multiple gestations and development of hypertension(HTN) later in life. This study aimed to determine whether multiple gestations are associated with HTN beyond the peripartum period. Methods: In this retrospective nationwide population-based study, women who delivered a baby between January 1, 2007, and December 31, 2008, and underwent a national health screening examination within one year prior to their pregnancy were included. Subsequently, we tracked the occurrence of HTN during follow-up until December 31, 2015, using International Classification of Diseases-10th Revision codes. Results: Among 362,821 women who gave birth during the study period, 4,944 (1.36%) women had multiple gestations. The cumulative incidence of HTN was higher in multiple gestations group compared with singleton group (5.95% vs. 3.78%, p < 0.01, respectively). On the Cox proportional hazards models, the risk of HTN was increased in women with multiple gestations (HR 1.35, 95% CI 1.19, 1.54) compared with those with singleton after adjustment for age, primiparity, preeclampsia, atrial fibrillation, body mass index, blood pressure, diabetes mellitus, high total cholesterol, abnormal liver function test, regular exercise, and smoking status. Conclusions: Multiple gestations are associated with an increased risk of HTN later in life. Therefore, guidelines for the management of high-risk patients after delivery should be established. [ABSTRACT FROM AUTHOR]

Objective  This study aims to estimate the association between abnormal placental histopathology, fetal growth restriction (FGR), and preeclampsia (PEC) in twin pregnancies. Study Design  Retrospective cohort study of women with diamniotic twin pregnancies with live births at ≥24 weeks of gestation and available placental pathology. Findings were compared between women with and without FGR, which was defined as a birthweight <10th percentile, using singleton and twin growth curves, and those with and without PEC. The primary study outcome was a composite of abnormal placental histopathology. Chi-square, Fisher's exact, and Student's t -tests were used for analysis. Results  Among 859 patients with diamniotic twins, 806 (93.8%) had placental pathology. A total of 422 (52.4%) women had at least one twin with FGR, using a singleton growth curve. FGR affected 136 (16.9%) pregnancies when a twin growth curve was applied. There was no significant difference in composite outcome between groups, using either growth curve (45.5 vs. 44.8%, p  = 0.84; adjusted odds ratio (aOR): 1.06, 95% CI: 0.79–1.40 and 52.2 vs. 43.7%, p  = 0.07; aOR: 1.44, 95% CI: 0.90–2.10). A total of 122 of 789 (15.5%) patients developed PEC. There was no significant difference in composite outcome between patients with and without PEC (41.8 vs. 45.4%, p  = 0.46; aOR: 0.79, 95% CI: 0.53–1.18). Conclusion  In twin pregnancies, FGR and PEC are not associated with abnormal placental histopathology. This suggests that the pathologic placental manifestations of these conditions may differ in twins and include factors other than those commonly described in singletons. [ABSTRACT FROM AUTHOR]

Background: As the number of older women attempting to conceive through donor oocyte-in vitro fertilization (DO-IVF) rises, their safety in pregnancy needs to be judiciously considered. Aims: This study aims to review the obstetric and perinatal outcomes of pregnancies achieved by DO-IVF. Study Setting and Design: A retrospective study design conducted at a private health facility with services for assisted reproduction and gynecologic endoscopy. Methods: A retrospective comparative study of all pregnancies achieved using DO-IVF and that using Self oocyte In-vitro fertilization (SO-IVF) treatment over a 3 years' period was performed. Statistical Analysis: Comparative analysis of demographic variables, major obstetric, and perinatal complications was done with Chi-square test and Student's t-test as appropriate. Regression analysis was done to determine a significant predictor variable for pregnancy and delivery outcome. The significance level was set at P < 0.05. Results: A total of 343 completed IVF treatment cycles was reviewed; there were 238 DO-IVF and 105 SO-IVF cycles, with clinical pregnancy rate of 41.6% and 37.1%, respectively. The DO-IVF group was significantly older than the SO-IVF group (46.1 years vs. 34.1 years, P < 0.001). Major obstetric complications identified, were hypertensive disorders in pregnancy (23.9%), preterm labor (16.7%), antepartum hemorrhage (11.6%). There was no statistically significant difference between the two groups in terms of obstetric complications and adverse maternal or perinatal outcomes. There were 97 (77.6%) singleton and 28 (22.4%) multiple pregnancies. Pregnancy complications were significantly associated with fetal plurality, P < 0.001. Multiple pregnancy had higher odds of experiencing adverse perinatal 4.96 (1.95-12.58) and maternal 7.16 (2.05-25.03) outcomes compared to singleton pregnancies, P < 0.001. Conclusion: Key obstetric outcomes did not differ between DO or SO IVF achieved pregnancy. Even for older women, satisfactory outcomes can be expected for pregnancies achieved by DO-IVF. It is, however, instructive that for multiple pregnancies, obstetricians should institute appropriate surveillance strategies during pregnancy and delivery period and also to develop institutional capacity for quality neonatal care. [ABSTRACT FROM AUTHOR]

Premature birth and its associated complications are one of the biggest global health problems, since there is currently no effective screening method in clinical practice to accurately identify the true Preterm Birth (PTB) from the false threatened ones. Despite the high prevalence of PTB in multiple gestation (MG) women which amounted up to 60%, in the literature there is any work about their uterine myoelectric activities in vivo system. Electrohysterography (EHG) has been emerged as an alternative technique for predicting PTB in single gestation (SG) women. The aim of this study was to characterize and compare the uterine myoelectrical activity in vivo system of SG and MG women in regular check-ups, to provide the basis for early detection and prevention of preterm labour in MG. A prospective observational cohort study was conducted on 31 SG and 18 MG women between the 28th and 32th WoG who underwent regular check-ups in the Polytechnic and University Hospital La Fe (Valencia, Spain). The 30-minute bipolar recording was filtered in the 0.1-4 Hz bandwidth and downsampled to 20 Hz. Signal analysis was performed in 120-second moving windows with 50% overlap, after removing artefacts by a double- blind expert process. A set of 8 temporal, spectral and non-linear parameters were calculated: root mean square (RMS), kurtosis of the Hilbert envelope (KHE), median frequency (MDF), H/L ratio, and sample entropy (SampEn) and bubble entropy (BubbEn) calculated in the whole bandwidth (WBW) and the fast wave high (FWH). The 10th, 50th and 90th percentiles of all windows analysed were calculated to obtain representative values of the recordings. For each parameter and percentile, statistically significant differences between the SG and MG groups and their statistical power (SP) were analysed to determine both the existence of an effect and substantive significance, respectively. In comparison to SG, MG EHG exhibited significant higher impulsiveness and higher predictability than SG which was reflected in the KHE (SP 10 = 85.2, p 10 < 0.001) and entropy measures (SampEn FWH: SP 50 = 62.0, p 50 = 0.0.016; SP 90 = 52.5, p 90 = 0.059. BubbEn FWH: SP 50 = 75.2, p 50 < 0.001; SP 90 = 60.3, p 90 = 0.002), suggesting an accelerated evolution of uterine electrophysiological condition. In addition, several EHG parameters were found to significantly correlate with foetal weight such as amplitude (RMS: r 90 = 0.311, p 90 = 0.006), signal impulsiveness (KHE: r 10 = 0.311, p 10 = 0.006) and entropy measures (SampEn FWH: r 50 = −0.317, p 50 = 0.005*; r 90 = −0.279, p 90 = 0.013*. BubbEn FWH: r 50 = −0.370, p 50 = 0.001*; r 90 = −0.313, p 90 = 0.005*), suggesting an electromechanical coupling between uterine overdistension and contractile activity in vivo system. In comparison to SG women, MG showed higher impulsiveness and predictability in early third gestational trimester, as reflected in KHE, SampEn and BubbEn, respectively. We found similar cell excitability between SG and MG women far from delivery. In addition, we confirmed the relationship between uterine overdistension and surface myoelectric activity, revealing the electromechanical coupling pathway in uterine smooth muscle. Therefore, contextualized EHG-biomarkers would provide valuable information for early detection of PTB risk, which would allow clinicians better PTB management through personalised therapeutic interventions. • EHG features in multiple pregnancy differ from singleton ones in third trimester. • Multiple pregnancies show greater impulsivity and predictability than singletons. • Uterine overdistension may cause accelerated biophysical process toward labour. • Overdistension should be considered as a risk factor for preterm birth prediction. [ABSTRACT FROM AUTHOR]

Background: Multiple gestation has been on the rise because of advancement in assisted reproductive technology. Triplet pregnancy is associated with fetal loss and preterm birth as its major complications. Spontaneous triplet pregnancy is rare. In the case of fetal loss, delayed interval delivery has been used to achieve delivery of the retained fetuses. There is no common approach to delayed interval delivery.Case: A 31-year-old East African lady with spontaneous triplet pregnancy presented to our institution at gestation age of 19 weeks with features of threatened miscarriage. One fetus was miscarried, and delayed interval delivery was done as an outpatient. At gestation age of 35 weeks, she delivered healthy twins by cesarean section.Conclusion: Delayed interval delivery improves neonatal outcomes of high-order pregnancy after fetal loss even in a resource-limited setting. [ABSTRACT FROM AUTHOR]

Twin‐twin transfusion syndrome (TTTS) complicates approximately 10% of monochorionic twin pregnancies and is associated with almost 90% mortality if left untreated. Fetoscopic laser photocoagulation (FLP) is the first‐line therapy for TTTS, and an overall twin survival rate of 75% and at least one survival rate of 90% have been established. We report a case of TTTS complicated with bleeding from the uterine wall by inserting the procedure after FLP. The patient consequently underwent emergency caesarean section. The bleeding was uncontrollable due to atonic bleeding and emergency hysterectomy was performed. To detect the possibility of amniotic fluid embolism (AFE), biochemical blood samples demonstrated that there was no inflow of fetal ingredients in blood vessels of uterine tissue. There was no evidence of damage to any specific vessels by histopathological staining. These findings indicated that the cause of massive bleeding was unlikely to have been AFE. It was concluded that atonic bleeding was likely caused by uncontrollable hemorrhage from an injury lesion where an endoscope had been inserted. [ABSTRACT FROM AUTHOR]

Major obstetrics and gynecology societies offer inconsistent recommendation regarding optimal delivery timing in uncomplicated dizygotic twins. We sought to investigate the impact of delivery timing within term gestation, in dizygotic twins, on the short- and long-term offspring morbidity. A prospectively analyzed cohort of dizygotic twin deliveries was conducted. All women delivered at a regional tertiary medical center, at term (≥37 0/7), between the years 1991 and 2014, were included. The primary exposure was delivery at 37 0/7–37 + 6/7 weeks, while delivery at ≥38 0/7 weeks' gestation was considered the reference. Neonatal short- and long-term outcomes according to hospitalizations of offspring up to 18 years of age due to cardiac, respiratory, hematological, neurological, and infectious morbidity were compared. Kaplan–Meier survival curves were used to compare cumulative incidences per each major-system hospitalization. Cox regression models were used to estimate the adjusted hazard ratios, while adjusting for variables with clinical importance. During the study period, 612 dizygotic twin deliveries met the inclusion criteria. Of them, 200 (31.3%) occurred at 37–37 6/7 weeks, and 412 (68.7%) occurred at ≥38 0/7 weeks' gestation. In the long-term analysis, rates of hospitalizations involving several major morbidity categories exhibited comparable rates in both groups. The Cox regression models did not demonstrate an independent association between gestational age within term and later major pediatric morbidity in offspring (total long-term morbidity: adjusted hazard ratio 1.33, 95% confidence interval 0.77–2.29). Dizygotic twin deliveries occurring at different gestational ages within term do not appear to significantly impact on major short- and long-term outcomes. [ABSTRACT FROM AUTHOR]

Objective The aim of this study is to determine if hyperglycemia in twin pregnancies without gestational diabetes mellitus (GDM) is associated with an increased risk of adverse pregnancy outcomes. Study Design Retrospective cohort study of twin pregnancies in a single Maternal–Fetal Medicine practice between 2005 and 2019 who underwent two-step GDM screening at 24 to 28 weeks. We excluded women with pregestational or gestational diabetes. We examined the association between maternal glycemia and adverse pregnancy outcomes. Glycemia was defined as the 1-hour GCT in all women, and each of the four values of the 3-hour OGTT in women who failed the GCT (≥130 mg/dL). Primary outcomes were preeclampsia, cesarean delivery, and neonatal hypoglycemia in either twin. Statistical tests used included Pearson's correlation, Student's t-test, Mann–Whitney U test, Chi-square test for trend, and logistic regression. Results A total of 847 women underwent a GCT and 246 women underwent an OGTT. Increasing maternal glucose levels had no positive association with adverse outcomes. Women with preeclampsia, cesarean delivery, and neonatal hypoglycemia did not have higher mean GCT or OGTT values than women without these outcomes. There was no increased risk of adverse outcomes with increasing quartiles of the GCT or OGTT values. Conclusion In women with twin pregnancies without GDM, elevated maternal glucose levels are not associated with preeclampsia, cesarean delivery, or neonatal hypoglycemia. The altered physiology of twin gestations may modify the effect of maternal hyperglycemia on perinatal outcomes as compared with singleton pregnancies. Current approaches to screening for and treating GDM during pregnancy might not adequately account for these unique considerations among twins.

Background: Twin gestation with its attendant complications has been on the rise worldwide. Its periodic evaluation is necessary to update the extent of its contribution to maternal morbidities. Objective: To determine the incidence and maternal antepartum, intrapartum, and postpartum complications associated with twin pregnancies. Materials and Methods: This was a retrospective study carried out in the Federal Medical Centre, Umuahia, Abia state, Nigeria, over a 5-year period from January 1, 2009, to December 31, 2013. During the period of study, there were 264 twin pregnancies, but only 186 folders had enough information for data analysis. Data were analyzed using WinPepi version 11.65. Statistical significance was calculated using Chi-square test with level of significance set at P < 0.05. Results: The incidence of twin pregnancy was 3.2% (32/1000 deliveries). The mean age was 29.5 ± 5 years. Most of the patients (35.5%) were aged between 25 and 29 years. Most of the patients (64.5%) were booked. Preterm delivery accounted for 30.6% of antenatal complications, while hypertensive disorders of pregnancy made up 14.5%. Majority of the patients (54.3%) had cesarean delivery, and the most common indication for cesarean delivery was malpresentation of the leading twin which accounted for 40.6% of the indications for cesarean deliveries. Anemia was the most common postpartum complication noted in 25.3% of patients and that was followed by primary postpartum hemorrhage with a rate of 10.8%. Conclusion: This study has highlighted the high incidence of twin pregnancy in our environment. It has also affirmed the significant maternal morbidities associated with this obstetric condition.

Summary: In this report we present an unusual case of a couple who achieved a twin pregnancy by intracytoplasmic sperm injection (ICSI) with a single immature oocyte retrieved. The oocyte was at metaphase I at 39 h post human chorionic gonadotrophin (hCG) administration, which is our standard ICSI time. Extended culture allowed the extrusion of the polar body, and sperm injection was performed at 43 h post-trigger. The fertilized egg underwent embryo biopsy on day 3 and preimplantation genetic assessment for three chromosomes (X, Y and 21). The embryo remained in culture until day 5. Later, the biopsy results reported a transferable embryo, which was replaced to the uterine cavity at blastocyst stage. Pregnancy test gave a positive β-hCG result, and the 6 weeks' scan, performed to confirm the fetal heart, revealed the presence of one amniotic sac and two fetal heartbeats, which currently have been so far eventless and smooth, ongoing at 18 weeks of gestation. [ABSTRACT FROM AUTHOR]

Multiple gestations are commonly encountered in both high-risk and low-risk pregnancies and, since the advent of assisted reproductive technologies in the 1980s, the numbers of multiple gestations have grown rapidly. Thus, an understanding of both the maternal and fetal risks associated with multiple gestations should be central to all obstetric practice. The ability to foresee issues and the know how to respond to the complications that develop are central to the correct management of these pregnant women. For some, appropriate management may include referral to a specialist maternal and fetal medicine physician or, in some cases, to a specialist fetal center. The present review provides a comprehensive and simplified overview of multiple gestations, including incidence, diagnosis, genetic considerations, complications (both general and specific to multiple gestation subtypes), and delivery management. It is essential that providers recognize the high-risk and specific complications that may affect a multiple gestation in order to provide the highest possible level of care for these pregnant women. [ABSTRACT FROM AUTHOR]

Background: Twin pregnancy is associated with increased perinatal mortality. Close foetal monitoring is therefore warranted. Doppler Ultrasound cardiotocography is currently the only available method to monitor both individual foetuses. Unfortunately, the performance measures of this method are poor and erroneous monitoring of the same twin with both transducers may occur, leaving the second twin unmonitored. In this study we aimed to determine the feasibility of monitoring both foetuses simultaneously in twin gestation by means of non-invasive foetal electrocardiography (NI-fECG), using an electrode patch on the maternal abdomen.Methods: A NI-fECG recording was performed at 25 + 3 weeks of gestation on a multiparous woman pregnant with dichorionic diamniotic twins. An electrode patch consisting of eight adhesive electrodes was applied on the maternal abdomen, yielding six channels of bipolar electrophysiological measurements. The output was digitized and stored for offline processing. The recorded signals were preprocessed by suppression of high-frequency noise, baseline wander, and powerline interference. Secondly, the maternal ECG was subtracted and segmentation into individual ECG complexes was performed. Finally, ensemble averaging of these individual ECG complexes was performed to suppress interferences.Results: Six different recordings were obtained from each of the six recording channels. Depending on the orientation and distance of the fetal heart with respect to each electrode, a distinction could be made between each fetus based on the morphology of the signals. Yielding of the fetal ECGs was performed manually based on the QRS complexes of each fetus.Conclusion: NI-fECG with multiple electrodes allows for monitoring of the fetal heart rate and ECG of both individual fetuses in twin pregnancies. [ABSTRACT FROM AUTHOR]

Background: Compared to singleton pregnancies, small for gestational age (SGA) and twin gestations experience adverse maternal and neonatal outcomes. Specific data regarding outcomes in late preterm SGA twin gestations are lacking.Objective: This study sought to compare pregnancy outcomes of late preterm (≥34 and <37 weeks) SGA twins versus singletons. In addition, we sought to stratify the comparisons by <10 and <5 percentile categories.Study design: In this retrospective cohort of 1.85 million pregnancies, we identified 10,646 nonanomalous, SGA, late preterm singleton and twin pregnancies. Births at gestational ages <34 and ≥37 weeks were excluded. Multivariate regression analyses and Chi-squared test were used for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.Results: After controlling for race, education, parity, prenatal care, diabetes, and hypertensive disease, twin pregnancies were less likely to experience neonatal death (aOR 0.14; 95% CI 0.03-0.63; p = .01) and intrauterine fetal demise (IUFD) (aOR 0.16; 95% CI 0.08-0.31; p < .001) compared to SGA <10 percentile singletons. Cesarean rates were higher in SGA <10 [percentile twin pregnancies (aOR 3.40; 95% CI 3.01-3.90; p < .001) as were postpartum hemorrhage (aOR 2.01; 95% CI 1.52-2.67; p < .001) and transfusion (aOR 1.54; 95% CI 1.52-2.67; p = .024).Conclusion: Late preterm SGA twin pregnancies were more like to be complicated by cesarean delivery, postpartum hemorrhage, and maternal transfusion compared to singleton pregnancies. However, neonatal death and IUFD were less common in SGA twin gestations. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective was to quantify the risk of perinatal mortality in non-anomalous monochorionic monoamniotic (MCMA) twin pregnancies complicated by birth-weight (BW) discordance. The secondary objectives were to investigate the effect of inpatient vs outpatient fetal monitoring on the risk of mortality in weight-discordant MCMA twin pregnancies, and to explore the predictive accuracy of BW discordance for perinatal mortality.Methods: This analysis included data on 242 MCMA twin pregnancies (484 fetuses) from three major research collaboratives on twin pregnancy (MONOMONO, STORK and NorSTAMP). The primary outcomes were the risks of intrauterine (IUD), neonatal (NND) and perinatal (PND) death, according to weight discordance at birth from ≥ 10% to ≥ 30%. The secondary outcomes were the association of inpatient vs outpatient fetal monitoring with the risk of mortality in weight-discordant pregnancies, and the accuracy of BW discordance in predicting mortality. Logistic regression and receiver-operating-characteristics-curve analyses were used to analyze the data.Results: The risk of IUD was significantly increased in MCMA twin pregnancies with BW discordance ≥ 10% (odds ratio (OR), 2.2; 95% CI, 1.1-4.4; P = 0.022) and increased up to an OR of 4.4 (95% CI, 1.3-14.4; P = 0.001) in those with BW discordance ≥ 30%. This association remained significant on multivariate logistic regression analysis for BW-discordance cut-offs ≥ 20%. However, weight discordance had low predictive accuracy for mortality, with areas under the receiver-operating-characteristics curve of 0.60 (95% CI, 0.46-0.73), 0.52 (95% CI, 0.33-0.72) and 0.57 (95% CI, 0.45-0.68) for IUD, NND and PND, respectively. There was no difference in the risk of overall IUD, single IUD, double IUD, NND or PND between pregnancies managed as an inpatient compared with those managed as an outpatient, for any BW-discordance cut-off.Conclusions: MCMA twin pregnancies with BW discordance are at increased risk of fetal death, signaling a need for increased levels of monitoring. Despite this, the predictive accuracy for mortality is low; thus, detection of BW discordance alone should not trigger intervention, such as iatrogenic delivery. The current data do not demonstrate an advantage of inpatient over outpatient management in these cases. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: History of prior preterm birth (PTB) represents one of the strongest risk factors for recurrent PTB. Nevertheless, whether the occurrence of PTB in multifetal gestation is associated with increased risk of PTB in subsequent pregnancies remains unclear. We aimed to determine the recurrence risk of PTB in a subsequent singleton pregnancy after a previous spontaneous preterm triplet delivery.Study Design: A retrospective matched case-control study. The study group comprised all women with spontaneous preterm trichorionic triplet delivery who had a subsequent singleton pregnancy during 2006-2017 at two university hospitals. A control group of women with spontaneous preterm dichorionic twin delivery and a subsequent singleton pregnancy, was established by matching, four-to-one, according to maternal age, parity, gestational age at delivery, and delivery year.Results: Data from 170 women were analyzed, 34 with preterm triplet delivery and 136 matched control women with preterm twin delivery. Gestational age at the subsequent singleton delivery was higher in those with preterm triplet delivery than in those with preterm twin delivery (median 39 vs 38 weeks, P = 0.02). Women with prior triplet PTB had a significantly lower rate of recurrent PTB as compared with women with prior twin PTB (5.9 % vs. 25.0 %; OR [95 % CI]: 0.19 (0.04, 0.82), P = 0.02) with lower proportions of low-birth weight infants (<2500 g) (0 % vs. 11.8 %, P = 0.04).Conclusions: The risk of recurrent PTB following spontaneous PTB in triplet pregnancy was low compared to preterm twin delivery. These data provide reassurance for those who experienced preterm triplet delivery and suggest the need for further studies to understand the mechanisms contributing to PTB in multifetal pregnancies. [ABSTRACT FROM AUTHOR]

Fetus papyraceus is a mummified fetus, which is related to multiple gestations.[1] In this rare condition, one fetus expires and becomes compressed between the uterine wall and membrane of the other fetus. Surviving infant is at high risk of developing complications secondary to the release of thrombi and other factors from the dead fetus; including prematurity, intrauterine growth retardation, gastroschisis, intestinal atresia, aplasia cutis, congenital heart abnormalities, and even death. We have reported consecutive case series in dichorionic diamniotic twins and monochorionic diamniotic twins successively. In our case reports, both pregnancies resulted in preterm deliveries and were managed successfully without any complications. [ABSTRACT FROM AUTHOR]