The incidence of multiple gestations is increasing with
increasing maternal age and use of assisted reproduction
techniques. Selective fetal reduction of multifetal pregnancies is now widely practiced to reduce the higher order multiples to twins based on evidence from nonrandomised studies which suggests that this will improve the perinatal outcome. The proportion of twin pregnancies with unique fetal and maternal problems is therefore increasing. Optimising maternal, fetal and perinatal outcomes in twin pregnancies continues to be a formidable challenge in the present day clinical practice.
Abstract— Cervical ripening is an essential factor for initiation of normal labour for vaginal delivery. Prior to onset of spontaneous labour the cervix undergoes a gradual process of ripening. But in certain cases it does not occur spontaneously at term and sometimes induction of labour is required. Then cervical ripening means high bishop score in essential for successful induction of labour. This comparative study was conducted at Bikaner to compare induction of labour by vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and Intra cervical Dinoprostone gel 0.5 mg. For this purpose 100 clients were given vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and 100 clients were given Intra cervical Dinoprostone gel 0.5 mg. It was observed in this study that Dinoprostone gel is more efficacious for cervical ripening and labour induction in cases of nulliparous & primiparous at term with unfavourable cervix with intact membranes, as compared to misoprostol in terms of shorter total duration of labour, shorter mean induction delivery interval, more spontaneous vaginal deliveries, and reduced incidence of LSCS as well as instrumental deliveries.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy
J Man, JC Hutchinson, M Ashworth, AE Heazell, S Levine and NJ Sebire
Volume 47, Issue 11; Date: November, pages 574–578
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16018/full
Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors
J Man, JC Hutchinson, M Ashworth, I Jeffrey, AE Heazell, and NJ Sebire
Volume 48, Issue 5; Date: November, pages 585–590
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16017/full
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
Abstract— Cervical ripening is an essential factor for initiation of normal labour for vaginal delivery. Prior to onset of spontaneous labour the cervix undergoes a gradual process of ripening. But in certain cases it does not occur spontaneously at term and sometimes induction of labour is required. Then cervical ripening means high bishop score in essential for successful induction of labour. This comparative study was conducted at Bikaner to compare induction of labour by vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and Intra cervical Dinoprostone gel 0.5 mg. For this purpose 100 clients were given vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and 100 clients were given Intra cervical Dinoprostone gel 0.5 mg. It was observed in this study that Dinoprostone gel is more efficacious for cervical ripening and labour induction in cases of nulliparous & primiparous at term with unfavourable cervix with intact membranes, as compared to misoprostol in terms of shorter total duration of labour, shorter mean induction delivery interval, more spontaneous vaginal deliveries, and reduced incidence of LSCS as well as instrumental deliveries.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy
J Man, JC Hutchinson, M Ashworth, AE Heazell, S Levine and NJ Sebire
Volume 47, Issue 11; Date: November, pages 574–578
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16018/full
Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors
J Man, JC Hutchinson, M Ashworth, I Jeffrey, AE Heazell, and NJ Sebire
Volume 48, Issue 5; Date: November, pages 585–590
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16017/full
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
Screening for trisomies 21, 18 and 13 by cell-free DNA analysis of maternal blood at 10–11 weeks’ gestation and the combined test at 11–13 weeks
M. S. Quezada, M. M. Gil, C. Francisco, G. Oròsz and K. H. Nicolaides
Volume 45, Issue 1, pages 36–41, January 2015
http://onlinelibrary.wiley.com/doi/10.1002/uog.14664/full
Genomic microarray in fetuses with increased nuchal translucency and normal karyotype: systematic review and meta-analysis
M. Grande, F. A. R. Jansen, Y. J. Blumenfeld, A. Fisher, A. O. Odibo, M. C. Haak and A. Borrell
Volume 46, Issue 6, Date: December, pages 650–658
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14880/abstract
Longitudinal hemodynamics in acute phase of treatment with labetalol in hypertensive pregnant women to predict need for vasodilatory therapy
D. Stott, M. Bolten, D. Paraschiv, I. Papastefanou, J.B. Chambers and N.A. Kametas
Volume 49, Issue 1, Date: January (pages 85–94)
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.17335/full
Serial hemodynamic monitoring to guide treatment of maternal hypertension leads to reduction in severe hypertension
D. Stott, I. Papastefanou, D. Paraschiv, K. Clark and N.A. Kametas
Volume 49, Issue 1, Date: January (pages 95–103)
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.17341/full
Slides prepared by Dr Katherine Goetzinger (UOG Editor for Trainees)
Course Director, Elizabeth A. Stewart, MD, prepared useful Practice Aids pertaining to uterine fibroids and endometriosis for this CME activity titled "Advances in Medical Options for Uterine Fibroids and Endometriosis: Clinical Highlights From Montreal." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HY3HDz. CME credit will be available until June 24, 2020.
Professor Soo Downe presenting at the Doctoral Midwifery Research Society Alcohol & Medication in Pregnancy Conferene about 'Which horse for which courses? The EBM Problem in studies of pharmacological substances in maternity care'.
Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure
M. Teixidor Vinas, A. M. Belli, S. Arulkumaran and E. Chandraharan
Volume 46, Issue 3, Date: September, pages 350–355
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14728/full
Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open‐label, randomized controlled trial
S Kehl, A Schelkle, A Thomas, A Puhl, K Meqdad, B Tuschy, S Berlit, C Weiss, C Bayer, J Heimrich, U Dammer, E Raabe, M Winkler, F Faschingbauer, MW Beckmann, M Sutterlin
Volume 47, Issue 6, Date: June (pages 674–679)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14924/full
Surgical treatment for hydrosalpinx prior to in‐vitro fertilization embryo transfer: a network meta‐analysis
A. Tsiami, A. Chaimani, D. Mavridis, M. Siskou, E. Assimakopoulos, A. Sotiriadis
Volume 48, Issue 4, Pages 434–445
Slides prepared by Dr Shireen Meher (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15900/full
Large randomized trial comparing transabdominal ultrasound-guided embryo transfer with a technique based on uterine length measurement before embryo transfer
A. Revelli, V. Rovei, P. Dalmasso, G. Gennarelli, C. Racca, F. Evangelista, C. Benedetto
Volume 48, Issue 3, Pages 289–295
Read the free-access article:http://onlinelibrary.wiley.com/doi/10.1002/uog.15899/full
Vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study
R. Romero, K. H. Nicolaides, A. Conde‐Agudelo, J. M. O'Brien, E. Cetingoz, E. Da Fonseca, G. W. Creasy, S. S. Hassan
Volume 48, Issue 3, Pages 308–317
Read the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15899/full
UOG Journal Club: Reassessing critical maternal antibody threshold in RhD alloimmunization: a 16-year retrospective cohort study
C. A. Walsh, B. Doyle, J. Quigley, F. M. McAuliffe, J. Fitzgerald, R. Mahony, S. Higgins, S. Carroll and P. McParland
Volume 44, Issue 6, pages 669–673, December 2014
http://onlinelibrary.wiley.com/doi/10.1002/uog.13383/abstract
Systematic review of accuracy of ultrasound in the diagnosis of vasa previa
L. Ruiter, N. Kok, J. Limpens, J.B. Derks, I.M. de Graaf, B.W.J. Mol and E. Pajkrt
Volume 45, Issue 5, pages 516–522, May 2015
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14752/full
Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small-for-gestational-age infant in women presenting with reduced symphysis–fundus height
M. Griffin, P. T. Seed, L. Webster, J. Myers, L. MacKillop, N. Simpson, D. Anumba, A. Khalil, M. Denbow, A. Sau, K. Hinshaw, P. von Dadelszen, S. Benton, J. Girling, C. W. G. Redman, L. C. Chappell and A. H. Shennan
Volume 46, Issue 2, pages 182–190, August 2015
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14860/full
Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data
V. Berghella, M. Palacio, A. Ness, Z. Alfirevic, K. H. Nicolaides and G. Saccone
Volume 49, Issue 3, Date: March (pages 322–329)
Slides prepared by Dr Shireen Meher (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17388/full
Neonatal Outcome In Pregnancy Induced Hypertensive Mothers – A Tertiary Care ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Dydrogesterone versus progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials
M. W. P. Barbosa, L. R. Silva, P. A. Navarro, R. A. Ferriani, C. O. Nastri and W. P. Martins
Volume 48, Issue 2, Pages 161–170
Slides prepared by Dr Aly Youssef (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15814/full
Screening for trisomies 21, 18 and 13 by cell-free DNA analysis of maternal blood at 10–11 weeks’ gestation and the combined test at 11–13 weeks
M. S. Quezada, M. M. Gil, C. Francisco, G. Oròsz and K. H. Nicolaides
Volume 45, Issue 1, pages 36–41, January 2015
http://onlinelibrary.wiley.com/doi/10.1002/uog.14664/full
Genomic microarray in fetuses with increased nuchal translucency and normal karyotype: systematic review and meta-analysis
M. Grande, F. A. R. Jansen, Y. J. Blumenfeld, A. Fisher, A. O. Odibo, M. C. Haak and A. Borrell
Volume 46, Issue 6, Date: December, pages 650–658
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14880/abstract
Longitudinal hemodynamics in acute phase of treatment with labetalol in hypertensive pregnant women to predict need for vasodilatory therapy
D. Stott, M. Bolten, D. Paraschiv, I. Papastefanou, J.B. Chambers and N.A. Kametas
Volume 49, Issue 1, Date: January (pages 85–94)
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.17335/full
Serial hemodynamic monitoring to guide treatment of maternal hypertension leads to reduction in severe hypertension
D. Stott, I. Papastefanou, D. Paraschiv, K. Clark and N.A. Kametas
Volume 49, Issue 1, Date: January (pages 95–103)
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.17341/full
Slides prepared by Dr Katherine Goetzinger (UOG Editor for Trainees)
Course Director, Elizabeth A. Stewart, MD, prepared useful Practice Aids pertaining to uterine fibroids and endometriosis for this CME activity titled "Advances in Medical Options for Uterine Fibroids and Endometriosis: Clinical Highlights From Montreal." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HY3HDz. CME credit will be available until June 24, 2020.
Professor Soo Downe presenting at the Doctoral Midwifery Research Society Alcohol & Medication in Pregnancy Conferene about 'Which horse for which courses? The EBM Problem in studies of pharmacological substances in maternity care'.
Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure
M. Teixidor Vinas, A. M. Belli, S. Arulkumaran and E. Chandraharan
Volume 46, Issue 3, Date: September, pages 350–355
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14728/full
Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open‐label, randomized controlled trial
S Kehl, A Schelkle, A Thomas, A Puhl, K Meqdad, B Tuschy, S Berlit, C Weiss, C Bayer, J Heimrich, U Dammer, E Raabe, M Winkler, F Faschingbauer, MW Beckmann, M Sutterlin
Volume 47, Issue 6, Date: June (pages 674–679)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14924/full
Surgical treatment for hydrosalpinx prior to in‐vitro fertilization embryo transfer: a network meta‐analysis
A. Tsiami, A. Chaimani, D. Mavridis, M. Siskou, E. Assimakopoulos, A. Sotiriadis
Volume 48, Issue 4, Pages 434–445
Slides prepared by Dr Shireen Meher (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15900/full
Large randomized trial comparing transabdominal ultrasound-guided embryo transfer with a technique based on uterine length measurement before embryo transfer
A. Revelli, V. Rovei, P. Dalmasso, G. Gennarelli, C. Racca, F. Evangelista, C. Benedetto
Volume 48, Issue 3, Pages 289–295
Read the free-access article:http://onlinelibrary.wiley.com/doi/10.1002/uog.15899/full
Vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study
R. Romero, K. H. Nicolaides, A. Conde‐Agudelo, J. M. O'Brien, E. Cetingoz, E. Da Fonseca, G. W. Creasy, S. S. Hassan
Volume 48, Issue 3, Pages 308–317
Read the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15899/full
UOG Journal Club: Reassessing critical maternal antibody threshold in RhD alloimmunization: a 16-year retrospective cohort study
C. A. Walsh, B. Doyle, J. Quigley, F. M. McAuliffe, J. Fitzgerald, R. Mahony, S. Higgins, S. Carroll and P. McParland
Volume 44, Issue 6, pages 669–673, December 2014
http://onlinelibrary.wiley.com/doi/10.1002/uog.13383/abstract
Systematic review of accuracy of ultrasound in the diagnosis of vasa previa
L. Ruiter, N. Kok, J. Limpens, J.B. Derks, I.M. de Graaf, B.W.J. Mol and E. Pajkrt
Volume 45, Issue 5, pages 516–522, May 2015
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14752/full
Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small-for-gestational-age infant in women presenting with reduced symphysis–fundus height
M. Griffin, P. T. Seed, L. Webster, J. Myers, L. MacKillop, N. Simpson, D. Anumba, A. Khalil, M. Denbow, A. Sau, K. Hinshaw, P. von Dadelszen, S. Benton, J. Girling, C. W. G. Redman, L. C. Chappell and A. H. Shennan
Volume 46, Issue 2, pages 182–190, August 2015
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14860/full
Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data
V. Berghella, M. Palacio, A. Ness, Z. Alfirevic, K. H. Nicolaides and G. Saccone
Volume 49, Issue 3, Date: March (pages 322–329)
Slides prepared by Dr Shireen Meher (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17388/full
Neonatal Outcome In Pregnancy Induced Hypertensive Mothers – A Tertiary Care ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Dydrogesterone versus progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials
M. W. P. Barbosa, L. R. Silva, P. A. Navarro, R. A. Ferriani, C. O. Nastri and W. P. Martins
Volume 48, Issue 2, Pages 161–170
Slides prepared by Dr Aly Youssef (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15814/full
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Preterm Premature Rupture of Membranes and Neonatal and Maternal Outcomesremedypublications2
The management of Preterm Premature Rupture of Membranes (PPROM) remains
controversial. PPROM may lead significant maternal and neonatal complications.
Methods: Retrospective data of PPROM cases managed in Suleymaniye Maternity Research and
Training Hospital between 2008 and 2012 were collected and analyzed using SPSS.
— Female genital tuberculosis is one of the major etiological factors of female infertility. Diagnosis of genital tuberculosis is very important in such cases. So this comparative observational type of study was carried out on infertile women to compare the diagnostic effectively of ultrasonograpgy (USG), genital tuberculosis, Tuberculin test, Nucleic acid amplification test (PCR), histopathology and hysteroscopy & laparoscopy (DHL) assuming culture as gold standard. It was observed that the 28% of infertile cases were found positive for genital tuberculosis on culture. Sensitivity of PCR 64.28%, DHL 92.85%, USG 42.85%, Histopathology 60.71% and Tuberculin Test 64.28%. So sensitivity was found with significant variation ranging from 42.85% with ultrasonography (USG) to 92.85% with DHL. Specificity of PCR 52.77%, DHL 55.55%, USG 98.61%, Histopathology 91.66% and Tuberculin Test 36.11%. So specificity was also found with significant variation being found maximum with USG (98.61%) and minimum with tuberculin test (36.11%). Positive predictive value (PPV) was found maximum (92.3%) with USG and minimum (28.12%) with tuberculin test and negative predictive value (NPV) was found maximum (95.23%) with DHL and minimum (72.22%) with tuberculin test. Diagnostic effectively of diagnosing GTB with various studied modalities vary with significant variation.
Dr Sujoy Dasgupta was invited to deliver a lecture at BOGSCON (The Annual Conference of Bengal Obstetric and Gynaecological Society) held at Kolkata in December 2019
Study of Incidence and Etiology of Prolapse at Rural Based Teaching Hospitaltheijes
In our country as large number of woman deliver at home, usually conducted by untrained dias, incidence of prolapse is higher. The etiology of prolapse was discussed by ARETAEUS, a Greek physician who believed procedentiato be result of weakness of ligaments of the uterus. There are multiple etiological factors in the developed of prolapse. Diagnosis of prolapse at the earliest will help to reduce the complications of prolapse as well as continue child bearing function of the young woman.
Clinical study of Eclampsia and outcome in a tertiary care centreiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...iosrjce
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AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AND INTERVENTION: A FOUR YEAR SURVEY
1. AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH
ACTIVE FETAL SURVEILLANCE AND INTERVENTION: A FOUR
YEAR SURVEY
2. Original Article
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL
SURVEILLANCE AND INTERVENTION: A FOUR YEAR SURVEY
Chinmayee Ratha* and Anita Kaul**
*Consultant, ** Senior Consultant & Clinical Coordinator, Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals,
Sarita Vihar, New Delhi 110 076, India.
Correspondence to: Dr Anita Kaul, Senior Consultant & Clinical Coordinator, Apollo Centre for Fetal Medicine,
Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110 076, India.
Introduction: The present study aims to highlight the prospects of improving fetal and perinatal outcomes in
twin pregnancies with active fetal surveillance and effective fetal therapeutic interventions. Study Design: 88
twin pregnancies booked for care at this centre were included in this study. The maternal demographic
variables, course of pregnancy, fetal problems and specialised fetal therapeutic and diagnostic interventions
were noted. The above parameters were also compared in dichorionic and monochorionic twin pregnancies
and related to the perinatal outcome. Statistical analysis was done using the student’s t test and two-tailed chi
sqaure tests with Yate’s continuity correction. A p value <0.05 was considered as significant. Results: Mean
maternal age was 30.34 ± 4.81 years (Range 19- 48). 81% of the twins were DCDA and 19% were MCDA. The
mean gestaional age at delivery was 34.4±3.5 weeks and this was not significantly different in MCDA and
DCDA groups. Serious fetal problems warranting intervention at thetime of initial referral were significantly
higher in MCDA twins although overall perinatal outcome in both groups were not different. Conclusion:
Active fetal surveillanve and therapeutic intervention improves the perinatal outcome to over 90% of at least
one take home baby rate but with an increase in late prematurity.
INTRODUCTION
The incidence of multiple gestations is increasing with
increasing maternal age and use of assisted reproduction
techniques. Selective fetal reduction of multifetal pregnancies is now widely practiced to reduce the higher order
multiples to twins based on evidence from nonrandomised
studies which suggests that this will improve the perinatal
outcome [1]. The proportion of twin pregnancies with
unique fetal and maternal problems is therefore increasing.
Optimising maternal, fetal and perinatal outcomes in twin
pregnancies continues to be a formidable challenge in the
present day clinical practice.
The present study aims to highlight the prospects of
improving fetal and perinatal outcomes in twin pregnancies
with active fetal surveillance and effective fetal therapeutic
interventions.
STUDY DESIGN
All twin pregnancies booked for care at this centre were
included in this study. This is a descrptive (cross sectional)
analysis of all twin pregnancies, who have delivered and
were managed at the Apollo Centre for Fetal Medicine, a
tertiary Fetal Medicine referral centre in North India over a
period of four years from Sep 2006 - Aug 2010. The
maternal demographic variables, course of pregnancy, fetal
Apollo Medicine, Vol. 7, No. 3, September 2010
200
problems and specialised fetal therapeutic and diagnostic
inter-ventions were noted. The above parameters were also
separately evaluated in dichorionic and monochorionic
twin pregnancies and correlated to the perinatal outcome.
Statistical analysis was done using the student’s t test
and two-tailed chi sqaure tests with Yate’s continuity
correction. A p value <0.05 was considered as significant.
RESULTS
Over a period of four years there were 101 twin pregnancies which accounted for 4.04% of all the pregnancies
booked for care at our centre. Five twin pregnancies are on
going while 8 cases were lost to follow up.
Eighty eight twin pregnancies (91.66% of the delivered
cases) were followed up till delivery and complete
outcomes with follow up until date are recorded (Table 16).
DISCUSSION
The incidence of twins in our population was 4% which
is higher than the expected incidence in the general
population (1%) because the present study represents a
cross section of high risk pregnancies which have been
referred to a tertiary fetal medicin fetal problems or for
routine care in anticipation of problems. 81% of the twins
3. Original Article
Table 1. Demographic features of study population
(n=88)
Table 4. Fetal and perinatal outcome measures in
study population
Mean maternal age(years)
30.34 + 4.81
(Range 19- 48)
Miscarriage of both twins ( <20weeks GA) 5 (5.68%)
Single fetal demise(<20 weeks GA)
2 (2.27%)
Spontaneous conception
44 (50%)
Cervical cerclage/Pessary
15(17.04%)
Ovulation Induction/IUI
15 (17%)
Mean Gestational age at delivery(weeks) 34.40+3.5
IVF/ICSI
29 (33%)
Preterm births(< 37 weeks GA)
65 (78.31%)
Prior Embryo reduction
8 (9.09%)
Early preterm births(<34 weeks GA)
22(26.51%)
Mean Gestational Age at
booking(weeks)
17.07+6.65
(Range 6-33)
Late preterm births(34 - 37 weeks GA)
43(51.81%)
Term births(%)
18 (20.46%)
Dichorionic Diamniotic twin
pregnancies
71 (81%)
Mean birth weight of babies(g)
1951.56+
575.17
Monochorionic Diamniotic
twin prgnancies
17 (19%)
Discordant anomalies
Live births
12 (16.9%)
10 (58.82%)
P = 0.0011
Routine Care
59(83.1%)
140 (86.4%)
5 (3.5%)
MCDA
Significant fetal problems
17 (10.3%)
Neonatal deaths
DCDA
50 (56.8%)
Late intrauterine fetal demise
Table 2. Indication for initial referral
9 (10.2%)
Discordant growth
7( 41.18%)
Table 5. Fetal therapeutic interventions
LASER ablation of umbilical cord in TRAP
NT (nuchal translucency)
Selective feticide of anomalous twin
21 (23.86%)
Second trimester genetic sonogram
26 (29.54%)
No assessment(booked after 20 weeks)
16 (18.18%)
Confirmed karyotype after risk
assessment(CVS/Amniocentesis)
3(3.36%)
Confirmed karyotype electively without
risk assessment
1(1.12%)
3
1
24 (27.27%)
Combined first trimester test
1
Serial Amniodrainage
Table 3. Different methods used for screening for
fetal aneuploidies
2
LASER septostomy in severe TTTS
were dichorionic (DCDA) while 19% were monochorionic
diamniotic (MCDA) (Fig.1).
A significantly higher proportion of the MCDA twins
were referred due to serious fetal problems(58.82%) as
compared to the DCDA twins(p=0.0011). DCDA twins
(92.3%) was significantly higher than MCDA (62.5%),
p<0.001. However the other parameters of perinatal
outcome like gestational age at delivery, mode of delivery
or birthweight of babies was not significantly different.
The increased possibility of complications and poor
perinatal outcomes in monochorionic twins as compared to
dichorionic twins has been established[2]. It has also been
shown that even after, exclusion of disorders unique to
monochorionic placentation, there is persistence of higher
perinatal complications in MCDA twins[3,4]. It is therefore
interesting to note that our outcomes were not significantly
different in the MCDA and DCDA subgroups inspite of
significantly higher proportion of MCDA twins referred
due to adverse fetal conditions. This can be attributed to the
successful fetal interventions and monitoring. Therapeutic
LASER ablation of the umbilical cord in the TRAP
sequences and the LASER septostomy in severe TTTS
helped salvage the co-twin and achieve one live birth.
These fetal interventions carry a risk of pregnancy loss as
was seen in one case in our series. These procedures must
be undertaken judiciously after elaborate counseling and by
an appropraitely trained operator.
Forty four (50%) pregnancies were conceived naturally
while 15 (17 %) had ovulation induction with or without
Intrauterine insemination (IUI) and 29(33%) had conceived
with either Invitro fertilisation (IVF) or Intra Cytoplasmic
Sperm Injection(ICSI) (Fig.2). Prior embryo reduction
from higher order multiples was performed in 8 cases
(9.09%).
201
Apollo Medicine, Vol. 7, No. 3, September 2010
4. Original Article
Table 6: Comparison of fetal and perinatal outcomes in DCDA and MCDA subgroups
DCDA (n=71)
MCDA (n=17)
P value
Mean Maternal Age(years)
30.76±4.8
31.00±6.24 0
0.094991198
Spontaneous conception
42(59.15%)
15(88.23%)
0.0012
Mean gestational age at booking(weeks)
17.54±6.74
19.7±5.68
0.050792407
Miscarriage
4(5.63%)
1(5.88)
0.9683
Discordant anomaly
5 (7.04%)
4 (23.52%)
0.1165
Discordant growth
42(16.9%)
8(18.75%)
0.5275
Late intrauterine fetal demise
5/130 (3.8%)
12/32(37.5%)
<0.001
Mean gestational age at delivery(weeks)
34.37±2.64
32.03±4.57
0.099103121
Early preterm births(<34 weeksGA)
16/67(23.88%)
6/16(36.75%)
0.6273
Late preterm births(34 - 37 weeks GA)
35/67(52.24%)
8/16 (50%)
0.6273
Term births( after 37 weeks GA)
16/67(23.88%)
2/16 (12.25%)
0.6305
62/67(92.53%)
10/16 (62.9%)
0.0009
Live births
120/130 (92.3%)
20/32 (62.7%)
<0.001
Mean birth weight(g)
2027.98±493.23
1591.25±777.59
0.00293327
Neonatal deaths
5 (3.5%)
–
–
LSCS
It is interesting that the proportion of spontaneous
conceptions and assisted conceptions were similar in the
overall study population. However significantly higher
number of MCDA twins had been spontaneously
conceived as compared to DCDA (p=0.0012).
The mean maternal age in the study population (n=88)
was 30.34±4.81 years with the range from 19 to 48 years.
The maternal age distribution in the study population is
shown in Fig.3.
Fig. 1: Distribution of chorionicity of twins in study population.
Fig. 2. Mode of conception
Apollo Medicine, Vol. 7, No. 3, September 2010
Fig.3. Maternal age distribution in study population.
202
5. Original Article
The mean gestational age at booking was 17.07±6.65
(Range 6-33). When we analysed the distribution of the
individual cases as per the gestation age at booking most
of the cases booked between 11-20 weeks (Fig.4).
Various options for screening for fetal aneuploidies
was offered to women depending on their gestational age
at booking (Fig. 5). All women who booked before 14
weeks were offered the nuchal translucency scan or the
combined first trimester screening test. Those who booked
between 14 and 20 weeks were offered the genetic
sonogram.
The optimum modality of screening for fetal
aneuploidy in twin pregnancies has remained
controversial. Emerging evidence supports the use of the
first trimester combined test with satisfactory efficacy in
twins. It is notable that the first trimester combined
screening has been offered as a routine test only since
2008 after the evidence supporting its use became strong
[5]. Prior to this, first trimester screening was based only
on the fetal nuchal translucency scan. All women were
offered screening for fetal aneuploidies and based on the
risk assessment were counselled about invasive testing to
confirm fetal karyotype. In the present study three women
underwent invasive fetal diagnostic procedures like
Chorionic Villus Sampling (CVS) and amniocentesis.
Three women were allocated high risks for fetal
aneuploidies after screening while one voluntarily opted
for CVS instead of any screening tests. All fetal karyotype
reports were normal and there was no procedure related
pregnancy loss.
The overall preterm delivery rate in the present study
population is 78.3% and the mean gestational age at
delivery is 34.4 weeks. This appears to be a very high rate
of preterm births and we analysed them to see the
distribution of early and late preterm births in this group.
We found that 33.85% of these were early preterm (<34
weeks) deliveries which were mostly due to pressing fetal
indications or spontaneous preterm labour. The incidence
of spontaneous preterm labour was 17.0%. A cervical
cerclage or pessary was inserted in 15 (17.04%) women
but the indications varied from previous history of
miscarriage, reduced cervical length in present pregnancy
to elective cerclage. The late preterm (between 34-37
weeks) accounted for 66.15% of all preterm deliveries.
Most of the deliveries were elective cesarean sections at
this gestation period accounting for the 51.81% incidence
of late preterm births.
If we analyse the distribution of gestational age at
delivery, most deliveries have taken place between 33-36
weeks of gestaion at which time the neonatal survival is of
the order of 95% (Fig. 6).
Fig.4. Gestational age at booking.
Fig.5. Various screening modalities offered to study population.
Fig.6. Distribution of gestational age at delivery.
We get the impression that twin pregnancies increase
the anxiety levels in the parents and caregivers which
manifests in an inclination towards earlier delivery.We
hope that with this study we can reassure obstetricians that
with active fetal surveillance it is safe to allow twin
pregnancies to continue to term thus reducing our
203
Apollo Medicine, Vol. 7, No. 3, September 2010
6. Original Article
alaraming preterm delivery rate of 78.3% in this group.
We also wish to thank Ms Sonika and Ms Komal for
helping us collect the outcomes and follow up data.
CONCLUSION
REFERENCES
The present study has shown that with active fetal
surveillance and intervention, perinatal outcome can be
improved in twin pregnancies. Especially in
monochorionic twins, appropriately timed therapeutic
interventions for TRAP and TTTS can help save the cotwin. Early identification and monitoring of growth
discrepancy can help optimising the time of delivery . It is
unclear whether such a protocol could increase the risk of
intervention and prematurity. We hope that this study helps
to reduce iatrogenic prematurity.
We are in the process of collecting the data of the
Neonatal outcomes of the pregnancies which delivered in
Indraprastha Apollo hospitals and their long term
followup.
1. Dodd J, Crowther C. Multifetal pregnancy reduction of
triplet and higher-order multiple pregnancies to twins.
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2. Hack KE, Derks JB, Elias SG, et al. Increased perinatal
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Carreras E, Gratacos E. Catalunya and Balears
Monochorionic Network. Twin chorionicity and the risk of
adverse perinatal outcome. Int J Gynaecol Obstet. 2007;
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ACKNOWLEDGEMENTS
4. Leduc L, Takser L, Rinfret D. Persistance of adverse
obstetric and neonatal outcomes in monochorionic twins
after exclusion of disorders unique to monochorionic
placentation. Am J Obstet Gynecol. 2005;193(5):16701675.
We wish to thank our colleagues in the Department of
Drs. Obstetrics and Gynaecology, Sohani Verma, Shakti
Bhan Khanna, Sushma Sinha, Geeta Chaddha, Madhu
Roy, Harmeet Malhotra without whom this study would
not have been possible.
5. Kagan KO, Wright D, Baker A, Sahota D, Nicolaides KH.
Screening for trisomy 21 by maternal age, fetal nuchal
translucency thickness, free beta-human chorionic
gonadotropin and pregnancy-associated plasma
protein-A. Ultrasound Obstet Gynecol. 2008;31(6):
618-624.
Apollo Medicine, Vol. 7, No. 3, September 2010
204
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Y uu e ht:w wy uu ec m/p l h s i ln i
o tb : t / w . tb . a o o o p a i a
p/
o
o
l
ts d
F c b o : t :w wfc b o . m/h A o o o p a
a e o k ht / w . e o k o T e p l H s i l
p/
a
c
l
ts
Si s ae ht:w wsd s aen t p l _ o p a
l e h r: t / w .i h r.e/ o o H s i l
d
p/
le
A l
ts
L k d : t :w wl k d . m/ mp n /p l -o p a
i e i ht / w . e i c c a y o oh s i l
n n p/
i
n no o
a l
ts
Bo : t :w wl s l e l . /
l ht / w . t a h a hi
g p/
e tk t n