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Evidence-based care of women with a multiple pregnancy

Dodd, J.; Crowther, C.
Fonte: Bailliere Tindall Publicador: Bailliere Tindall
Tipo: Artigo de Revista Científica
Publicado em //2005 EN
Relevância na Pesquisa
36.23%
Women with a multiple pregnancy face greater risks for themselves and their infants than women pregnant with one child. Pre-pregnancy care should focus on avoiding multiple pregnancy. Early prenatal care centres on determining chorionicity and screening for fetal anomalies, with later care focusing on the presentation, prediction and management of preterm birth, and intrauterine growth restriction. The optimal timing and mode of birth are the focus of current multicentre, randomised, controlled trials. However, the data from such trials on care for women with a multiple pregnancy are limited. Many areas of care require better-quality information, including when using assisted reproductive techniques, the optimal number of embryos to be transferred, care after the diagnosis of chorionicity, and the benefits of specialised multiple pregnancy clinics. Better-quality information is required to inform clinical practice for women with complications of multiple pregnancy, including monoamniotic twin pregnancy, treatment of twin-to-twin transfusion syndrome, and care following single intrauterine fetal death.; http://www.elsevier.com/wps/find/journaldescription.cws_home/623004/description#description; Copyright © 2004 Elsevier Ltd All rights reserved.

Reducing multiple pregnancy from assisted reproduction treatment: educating patients and medical staff

Wang, J.; Lane, M.; Norman, R.
Fonte: Australasian Med Publ Co Ltd Publicador: Australasian Med Publ Co Ltd
Tipo: Artigo de Revista Científica
Publicado em //2006 EN
Relevância na Pesquisa
46.14%
Multiple pregnancy, with its adverse outcomes, is a significant problem in assisted reproductive technology. Single embryo transfer (SET) is the only feasible solution for reducing the rate of multiple pregnancy. Many patients and some clinicians remain to be convinced that SET is a better clinical option. Adequate education, based on available evidence, is one important way to promote the use of SET.; Jim Wang, Michelle Lane and Robert J Norman; The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.

Timing of birth for women with a twin pregnancy at term: A randomised controlled trial

Dodd, J.; Crowther, C.; Haslam, R.; Robinson, J.
Fonte: BioMed Central Ltd. Publicador: BioMed Central Ltd.
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
Relevância na Pesquisa
46.12%
Background: There is a well recognized risk of complications for both women and infants of a twin pregnancy, increasing beyond 37 weeks gestation. Preterm birth prior to 37 weeks gestation is a recognized complication of a twin pregnancy, however, up to 50% of twins will be born after this time. The aims of this randomised trial are to assess whether elective birth at 37 weeks gestation compared with standard care in women with a twin pregnancy affects the risk of perinatal death, and serious infant complications. Design: Multicentred randomised trial. Inclusion Criteria: women with a twin pregnancy at 366 weeks or more without contraindication to continuation of pregnancy. Trial Entry & Randomisation: Following written informed consent, eligible women will be randomised from 36+6 weeks gestation. The randomisation schedule uses balanced variable blocks, with stratification for centre of birth and planned mode of birth. Women will be randomised to either elective birth or standard care. Treatment Schedules: Women allocated to the elective birth group will be planned for elective birth from 37 weeks gestation. Where the plan is for vaginal birth, this will involve induction of labour. Where the plan is for caesarean birth, this will involve elective caesarean section. For women allocated to standard care...

Trends in preterm birth: singleton and multiple pregnancies in the Netherlands, 2000-2007

Schaaf, J.; Mol, B.; Abu-Hanna, A.; Ravelli, A.
Fonte: Blackwell Science Publicador: Blackwell Science
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
45.84%
Objective.  Several studies have reported increasing trends in preterm birth in developed countries, mainly attributable to an increase in medically indicated preterm births. Our aim was to describe trends in preterm birth among singleton and multiple pregnancies in the Netherlands. Design.  Prospective cohort study. Setting.  Nationwide study. Population.  We studied 1 451 246 pregnant women from 2000 to 2007. Methods.  We assessed trends in preterm birth. We subdivided preterm birth into spontaneous preterm birth after premature prelabour rupture of membranes (pPROM), medically indicated preterm birth and spontaneous preterm birth without pPROM. We performed analyses separately for singletons and multiples. Main outcome measures.  The primary outcome was preterm birth, defined as birth before 37 weeks of gestation, with very preterm birth (<32 weeks of gestation) being a secondary outcome. Results.  The risk of preterm birth was 7.7% and the risk of very preterm birth was 1.3%. In singleton pregnancies, the preterm birth risk decreased significantly from 6.4% to 6.0% (P < 0.0001), mainly as a result of the decrease in spontaneous preterm birth without pPROM (3.6–3.1%, P < 0.0001). In multiple pregnancies, the preterm birth risk increased significantly (47.3–47.7%...

Pessaries in multiple pregnancy as a prevention of preterm birth: the ProTwin trial

Hegeman, M.; Bekedam, D.; Bloemenkamp, K.; Kwee, A.; Papatsonis, D.; van der Post, J.; Lim, A.; Scheepers, L.; Willekes, C.; Duvekot, J.; Spaanderman, M.; Porath, M.; van Eyck, J.; Haak, M.; van Pampus, M.; Bruinse, H.; Mol, B.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
46.14%
BACKGROUND Multiple pregnancies are at high risk for preterm birth, and therefore an important cause of infant mortality and morbidity. A pessary is a simple and potentially effective measure for the prevention of preterm birth. Small studies have indicated its effectiveness, but large studies with sufficient power on the subject are lacking. Despite this lack of evidence, the treatment is at present applied by some gynaecologists in The Netherlands. METHODS/DESIGN We aim to investigate the hypothesis that prophylactic use of a cervical pessary will be effective in the prevention of preterm delivery and the neonatal mortality and morbidity resulting from preterm delivery in multiple pregnancy. We will evaluate the costs and effects of this intervention. At study entry, cervical length will be measured. Eligible women will be randomly allocated to receive either a cervical pessary or no intervention. The cervical pessary will be placed in situ at 16 to 20 weeks, and will stay in situ up to 36 weeks gestation or until delivery, whatever comes first. The primary outcome is composite bad neonatal condition (perinatal death or severe morbidity). Secondary outcome measures are time to delivery, preterm birth rate before 32 and 37 weeks, days of admission in neonatal intensive care unit...

17-alpha-hydroxyprogesterone caproate for the prevention of adverse neonatal outcome in multiple pregnancies: A randomized controlled trial

Lim, A.; Schuit, E.; Bloemenkamp, K.; Bernardus, R.; Duvekot, J.; Erwich, J.; van Eyck, J.; Groenwold, R.; Hasaart, T.; Hummel, P.; Kars, M.; Kwee, A.; van Oirschot, C.; van Pampus, M.; Papatsonis, D.; Porath, M.; Spaanderman, M.; Willekes, C.; Wilpshaar,
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
46.14%
OBJECTIVE: To estimate whether administration of 17[alpha]-hydroxyprogesterone caproate can prevent neonatal morbidity in multiple pregnancies by reducing the preterm birth rate. METHODS: We conducted a multicenter, double-blind, placebo-controlled randomized trial in 55 obstetric clinics in the Netherlands. Women with a multiple pregnancy were randomized to weekly injections of either 250 mg 17[alpha]-hydroxyprogesterone caproate or placebo, starting between 16 and 20 weeks of gestation and continuing until 36 weeks of gestation. The main outcome measure was adverse neonatal outcome. Secondary outcome measures were gestational age at delivery and delivery before 28, 32, and 37 weeks of gestation. RESULTS: We randomized 671 women. A composite measure of adverse neonatal outcome was present in 110 children (16%) born to mothers in the 17[alpha]-hydroxyprogesterone caproate group, and in 80 children (12%) of mothers in the placebo group (relative risk [RR] 1.34; 95% confidence interval [CI] 0.95–1.89). The mean gestational age at delivery was 35.4 weeks for the 17[alpha]-hydroxyprogesterone caproate group and 35.7 weeks for the placebo group (P=.32). Treatment with 17[alpha]-hydroxyprogesterone caproate did not reduce the delivery rate before 28 weeks (6% in the 17[alpha]-hydroxyprogesterone caproate group compared with 5% in the placebo group...

Serum relaxin in pregnancy

Maclennan, A.; Nicolson, R.; Green, R.
Fonte: Elsevier Science Publicador: Elsevier Science
Tipo: Artigo de Revista Científica
Publicado em //1986 EN
Relevância na Pesquisa
45.96%
Serum relaxin immunoactivity was measured by means of a porcine radioimmunoassay in a cross-sectional study of 302 normal singleton pregnancies. Concentrations in the third trimester were lower than in early and mid pregnancy. At term, relaxin levels in patients who went into spontaneous labour within a week of sampling were significantly lower than in those who did not. However, relaxin levels were highest during labour and fell almost to non-pregnant levels by the third postnatal day. Levels in twin pregnancies in the third trimester were higher than those in singleton pregnancies. Serial samples from 4 patients with a history of premature labour showed declining, very low levels in the only patient who subsequently had a preterm delivery. These results are compatible with the proposed roles of relaxin during pregnancy: namely, to maintain myometrial quiescence, facilitate uterine stromal remodelling during uterine growth, and promote cervical ripening at the onset of parturition.; Alastair H. Maclennan, Ruth Nicolson, Roslyn C. Green

Evolución de los partos múltiples en la Región de Murcia desde 1996 hasta 2008. Implicaciones psicosociales.; Evolution of multiple deliveries in the Region of Murcia from 1996 to 2008: psychosocial implications

Tornero Gómez, M.J.; Sánchez Romera, J.F.; Colodro Conde, L.; Ordoñana Martín, Juan Ramón
Fonte: Murcia : Servicio de Publicaciones de la Universidad de Murcia Publicador: Murcia : Servicio de Publicaciones de la Universidad de Murcia
Tipo: Artigo de Revista Científica Formato: application/pdf
SPA
Relevância na Pesquisa
45.89%
Los partos múltiples conllevan una serie de implicaciones psicosociales que afectan tanto a los padres como a los sistemas de atención sanitaria y social. La posibilidad de que se produzcan complicaciones se incrementa en el caso de un embarazo múltiple, así como las necesidades de atención y cuidados tanto para los bebés como para los padres. Disponer de información acerca de la evolución de este tipo de embarazos resulta, por tanto, de gran relevancia para identificar necesidades de salud en la población. Objetivos: Este trabajo tiene como principales objetivos presentar la evolución de los partos múltiples entre los años 1996 y 2008, tanto en la Región de Murcia como en España, examinar estos datos en función de la edad de la madre en el momento del nacimiento y analizar las posibles repercusiones de esta evolución. Método: Para ello se ha utilizado la información disponible en las bases de datos del Instituto Nacional de Estadística y del Centro Regional de Estadística de Murcia. Resultados: En los últimos años se ha producido un importante aumento en el número de partos múltiples tanto a nivel nacional como en las distintas comunidades autónomas, la Región de Murcia entre ellas. La tasa de partos gemelares o de orden mayor ha pasado a ser de 13.1‰ en 1996 a 18.4‰ en 2008 en Murcia (12.7‰ a 19.4‰ en España). El mayor incremento se ha producido en los grupos de madres a partir de los 30 años. Conclusiones: Esta situación presenta implicaciones importantes para el sistema de salud en su conjunto y para las familias. Éstas necesitan conseguir una adaptación en la que puede colaborar de forma decisiva el profesional sanitario proporcionando una información y orientación adecuadas.; ABSTRACT Multiple delivery carries a series of psychosocial implications which concern both the parents and the social and health care systems. The possibility of complications increases in multiple pregnancies...

Reduction of the number of fetuses for women with a multiple pregnancy

Dodd, J.; Crowther, C.
Fonte: Update Software Ltd Publicador: Update Software Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
46.24%
BACKGROUND When couples are faced with the dilemma of a higher-order multiple pregnancy there are three options. Termination of the entire pregnancy has generally not been acceptable to women, especially for those with a past history of infertility. Attempting to continue with all the fetuses is associated with inherent problems of preterm birth, survival and long-term morbidity. The other alternative relates to reduction in the number of fetuses by selective termination. The acceptability of these options for the couple will depend on their social background and underlying beliefs. This review focused on reduction in the number of fetuses. OBJECTIVES To assess a policy of multifetal reduction with a policy of expectant management of women with a multiple pregnancy. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 June 2012). SELECTION CRITERIA Randomised controlled trials with reported data that compared outcomes in mothers and babies who were managed expectantly with outcomes in women who underwent selective fetal reduction of a multiple pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS There were no randomised controlled trials identified. AUTHORS' CONCLUSIONS We found no available data from randomised trials to inform the risks and benefits of pregnancy reduction procedures for women with a multiple pregnancy. While randomised controlled trials will provide the most reliable evidence about the risks and benefits of fetal reduction procedures...

Elective birth at 37 weeks' gestation for women with an uncomplicated twin pregnancy

Dodd, J.M.; Deussen, A.R.; Grivell, R.M.; Crowther, C.A.
Fonte: Cochrane Collaboration Publicador: Cochrane Collaboration
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
Relevância na Pesquisa
46.02%
BACKGROUND: The optimal timing of birth for women with an otherwise uncomplicated twin pregnancy at term is uncertain, with clinical support for both elective delivery at 37 weeks, as well as expectant management (awaiting the spontaneous onset of labour). OBJECTIVES: To assess a policy of elective delivery from 37 weeks' gestation compared with an expectant approach for women with an otherwise uncomplicated twin pregnancy. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (12 December 2013). SELECTION CRITERIA: Randomised controlled trials with reported data that compared outcomes in mothers and babies who underwent elective delivery from 37 weeks' gestation in a twin pregnancy with outcomes in controls who were managed expectantly. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed trial eligibility, trial quality and extracted data from the included trials. MAIN RESULTS: Two randomised controlled trials comparing elective birth at 37 weeks for women with an uncomplicated twin pregnancy, with expectant management were included, involving 271 women and 542 infants. One trial was at an overall low risk of bias, and one trial was at unclear risk of selection bias...

Cervical pessaries for prevention of preterm birth in women with a multiple pregnancy (ProTWIN): a multicentre, open-label randomised controlled trial

Liem, S.; Schuit, E.; Hegeman, M.; Bais, J.; de Boer, K.; Bloemenkamp, K.; Brons, J.; Duvekot, H.; Nij Bijvanck, B.; Franssen, M.; Gaugler, I.; de Graaf, I.; Oudijk, M.; Papatsonis, D.; Pernet, P.; Porath, M.; Scheepers, L.; Sikkema, M.; Sporken, J.; Viss
Fonte: Lancet Publicador: Lancet
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
46.18%
Background: In women with a multiple pregnancy, spontaneous preterm delivery is the leading cause of perinatal morbidity and mortality. Interventions to reduce preterm birth in these women have not been successful. We assessed whether a cervical pessary could effectively prevent poor perinatal outcomes. Methods: We undertook a multicentre, open-label randomised controlled trial in 40 hospitals in the Netherlands. We randomly assigned women with a multiple pregnancy between 12 and 20 weeks' gestation (1:1) to pessary or control groups, using a web-based application with a computer-generated list with random block sizes of two to four, stratified by hospital. Participants and investigators were aware of group allocation. For women in the pessary group, a midwife or obstetrician inserted a cervical pessary between 16 and 20 weeks' gestation. Women in the control group did not receive the pessary, but otherwise received similar obstetrical care to those in the pessary group. The primary outcome was a composite of poor perinatal outcome: stillbirth, periventricular leucomalacia, severe respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular haemorrhage, necrotising enterocolitis, proven sepsis, and neonatal death. Analyses were by modified intention to treat. This trial is registered in the Dutch trial registry...

Hospitalisation and bed rest for multiple pregnancy (Review)

Crowther, C.; Han, S.
Fonte: Update Software Ltd Publicador: Update Software Ltd
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
Relevância na Pesquisa
46.26%
BACKGROUND: Bed rest used to be widely advised for women with a multiple pregnancy. OBJECTIVES: The objective was to assess the effect of bed rest in hospital for women with a multiple pregnancy for prevention of preterm birth and other fetal, neonatal and maternal outcomes. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2010). SELECTION CRITERIA: Randomised trials which compare outcomes in women with a multiple pregnancy and their babies who were offered bed rest in hospital with women only admitted to hospital if complications occurred. DATA COLLECTION AND AN ANALYSIS: The review authors carried out assessment for inclusion and risk of bias of the trials. We extracted and double entered data, and used a random-effects model. MAIN RESULTS: We included seven trials which involved 713 women and 1452 babies. Routine bed rest in hospital for multiple pregnancy did not reduce the risk of preterm birth, or perinatal mortality. There was substantial heterogeneity related to perinatal death and stillbirth unaccounted for by trial quality. There was a suggestion of a decreased number of low birthweight infants (less than 2500 g) born to women in the routinely hospitalised group (risk ratio (RR) 0.92; 95% confidence interval (CI) 0.85 to 1.00). No differences were seen in the number of very low birthweight infants (less than 1500 g). No support for the policy was found for other neonatal outcomes. No information is available on developmental outcomes for infants in any of the trials. For the secondary maternal outcomes reported of developing hypertension and caesarean delivery...

Specialised antenatal clinics for women with a multiple pregnancy for improving maternal and infant outcomes

Dodd, J.; Crowther, C.
Fonte: Update Software Ltd Publicador: Update Software Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
46.28%
BACKGROUND Regular antenatal care for women with a multiple pregnancy is accepted practice, and while most women have an increase in the number of antenatal visits, there is no consensus as to what constitutes optimal care. 'Specialised' antenatal clinics have been advocated as a way of improving outcomes for women and their infants. OBJECTIVES To assess, using the best available evidence, the benefits and harms of 'specialised' antenatal clinics compared with 'standard' antenatal care for women with a multiple pregnancy. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 April 2012). SELECTION CRITERIA All published, unpublished, and ongoing randomised controlled trials with reported data that compared outcomes in mothers and babies with a multiple pregnancy who received antenatal care specifically designed for women with a multiple pregnancy (as defined by the trial authors) with outcomes in controls who received 'standard' antenatal care (as defined by the trial authors). DATA COLLECTION AND ANALYSIS Both review authors independently assessed trials for inclusion and trial quality. Both review authors extracted data. Data were checked for accuracy. MAIN RESULTS There were data available from one study included in the review involving 162 women with a multiple pregnancy. For the only reported primary outcome...

Specialised antenatal clinics for women with a multiple pregnancy to improve maternal and infant outcomes

Dodd, J.; Crowther, C.
Fonte: Update Software Ltd Publicador: Update Software Ltd
Tipo: Artigo de Revista Científica
Publicado em //2007 EN
Relevância na Pesquisa
46.22%
Background Regular antenatal care for women with a multiple pregnancy is accepted practice, and while most women have an increase in the number of antenatal visits, there is no consensus as to what constitutes optimal care. 'Specialised' antenatal clinics have been advocated as a way of improving outcomes for women and their infants. Objectives To assess, using the best available evidence, the benefits and harms of 'specialised' antenatal clinics compared with 'standard' antenatal care for women with a multiple pregnancy. Search strategy We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2006), the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library 2005, Issue 4), and PubMed (January 1966 to January 2006). Selection criteria Randomised controlled trials with reported data that compared outcomes in mothers and babies who received 'specialised' antenatal care with outcomes in mothers and babies who received 'standard' antenatal care. Data collection and analysis Both review authors independently assessed trial quality and extracted data. Main results There are no included studies. Authors' conclusions There is no information available from randomised controlled trials to support the role of 'specialised' antenatal clinics for women with a multiple pregnancy compared with 'standard' antenatal care in improving maternal and infant health outcomes. The value of 'specialised' multiple pregnancy clinics in improving health outcomes for women and their infants requires evaluation in appropriately powered and designed randomised controlled trials; Dodd JM...

Reduction of the number of fetuses for women with triplet and higher order multiple pregnancies

Dodd, J.; Crowther, C.
Fonte: Update Software Ltd Publicador: Update Software Ltd
Tipo: Artigo de Revista Científica
Publicado em //2003 EN
Relevância na Pesquisa
46.23%
BACKGROUND: When couples are faced with the dilemma of a higher order multiple pregnancy there are three options. Termination of the entire pregnancy has generally not been acceptable to women, especially for those with a past history of infertility. Attempting to continue with all the fetuses is associated with inherent problems of preterm birth, survival and long term morbidity. The other alternative relates to reduction in the number of fetuses by selective termination. The acceptability of these options for the couple will depend on their social background and underlying beliefs. This review focused on reduction in the number of fetuses. OBJECTIVES: To assess a policy of multifetal reduction with a policy of expectant management of women with a triplet or higher order multiple pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (30 September 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002), and PubMed (to 30 September 2002). SELECTION CRITERIA: Randomized controlled trials with reported data that compared outcomes in mothers and babies who were managed expectantly with outcomes in women who underwent selective fetal reduction of a triplet or higher order multiple pregnancy. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: There were no randomised controlled trials identified. REVIEWER'S CONCLUSIONS: There are insufficient data available to support a policy of pregnancy reduction procedures for women with a triplet or higher order multiple pregnancy. While randomised controlled trials will provide the most reliable evidence about the risks and benefits of fetal reduction procedures...

Elective delivery of women with a twin pregnancy from 37 weeks' gestation

Dodd, J.; Crowther, C.
Fonte: Update Software Ltd Publicador: Update Software Ltd
Tipo: Artigo de Revista Científica
Publicado em //2003 EN
Relevância na Pesquisa
46.01%
BACKGROUND: The optimal timing of birth for women with an otherwise uncomplicated twin pregnancy at term is uncertain, with clinical support for both elective delivery at 37 weeks, as well as expectant management (awaiting the spontaneous onset of labour). OBJECTIVES: To assess a policy of elective delivery from 37 weeks' gestation compared with an expectant approach for women with an otherwise uncomplicated twin pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (searched 8 July 2002), Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002) and PubMed (January 1966 to 8 July 2002). SELECTION CRITERIA: Randomized controlled trials with reported data which compared outcomes in mothers and babies who underwent elective delivery from 37 weeks' gestation in a twin pregnancy with outcomes in controls who were managed expectantly. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Outcomes listed were collected from the identified trial. MAIN RESULTS: A single randomised controlled trial comparing elective induction of labour at 37 weeks for women with a twin pregnancy with expectant management was identified. A total of 36 women were recruited to the trial with 17 women allocated to the induction of labour group and 19 women to the expectant management group. For primary outcomes...

Hospitalisation and bed rest for multiple pregnancy

Crowther, C.
Fonte: Update Software Ltd Publicador: Update Software Ltd
Tipo: Artigo de Revista Científica
Publicado em //2000 EN
Relevância na Pesquisa
46.27%
BACKGROUND: Bed rest used to be widely advised for women with a multiple pregnancy. OBJECTIVES: The objective was to assess the effect of bed rest in hospital for women with a multiple pregnancy for prevention of preterm birth and other fetal, neonatal and maternal outcomes. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and reference lists of relevant articles were searched. Date of last search: August 2000. SELECTION CRITERIA: Randomised trials which compare outcomes in women with a multiple pregnancy and their babies who were offered bed rest in hospital with women only admitted to hospital if complications occurred. DATA COLLECTION AND ANALYSIS: Assessment for inclusion and methodological quality of the trials was done by the reviewer. Data were extracted by the reviewer and double entered. All eligible trials were included in the initial analysis. Prespecified sensitivity analyses have been carried out to evaluate the effect of trial quality, the effects of hospitalisation for bed rest in women with an uncomplicated twin pregnancy, in women with a triplet pregnancy and in women with a twin pregnancy complicated by cervical effacement and dilatation prior to labour. MAIN RESULTS: Six trials were included which involved over 600 women and 1400 babies. (1) Analyses of all trials. Routine bed rest in hospital for multiple pregnancy did not reduce the risk of preterm birth...

Successful twin pregnancy after orthotopic liver transplantation

Coelho,Júlio Cezar Uili; Parolin,Mônica Beatriz; Matias,Jorge E. Fouto
Fonte: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED Publicador: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2002 EN
Relevância na Pesquisa
45.96%
AIM: Report of a case of successful twin pregnancy following liver transplantation. PATIENT AND METHOD: A 42-year-old nulliparous-woman was subjected to an orthotopic liver transplantation due to Budd-Chiari syndrome. Sixteen months after the transplantation, an ultrasonography revealed twin pregnancy. Her prenatal course was uneventful, except for mild arterial hypertension. The immunosuppressive agents used during pregnancy were cyclosporine and prednisone. RESULT: The patient gave birth to two healthy girls at 37 weeks of gestation. The patient's postpartum course was uneventful with normal liver and renal function tests. CONCLUSION: Following successful pregnancy, women may become pregnant and give birth to normal children, including twins

The INeS study: Prevention of multiple pregnancies: A randomised controlled trial comparing IUI COH versus IVF e SET versus MNC IVF in couples with unexplained or mild male subfertility

Bensdorp, A.; Slappendel, E.; Koks, C.; Oosterhuis, G.; Hoek, A.; Hompes, P.; Broekmans, F.; Verhoeve, H.; de Bruin, J.; van Weert, J.M.; Traas, M.; Maas, J.; Beckers, N.; Repping, S.; Mol, B.; van der Veen, F.; van Wely, M.
Fonte: BioMed Central Ltd. Publicador: BioMed Central Ltd.
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
46.25%
BACKGROUND Multiple pregnancies are high risk pregnancies with higher chances of maternal and neonatal mortality and morbidity. In the past decades the number of multiple pregnancies has increased. This trend is partly due to the fact that women start family planning at an increased age, but also due to the increased use of ART. Couples with unexplained or mild male subfertility generally receive intrauterine insemination IUI with controlled hormonal stimulation (IUI COH). The cumulative pregnancy rate is 40%, with a 10% multiple pregnancy rate. This study aims to reveal whether alternative treatments such as IVF elective Single Embryo Transfer (IVF e SET) or Modified Natural Cycle IVF (MNC IVF) can reduce the number of multiple pregnancy rates, but uphold similar pregnancy rates as IUI COH in couples with mild male or unexplained subfertility. Secondly, the aim is to perform a cost effective analyses and assess treatment preference of these couples. METHODS/DESIGN We plan a multicentre randomised controlled clinical trial in the Netherlands comparing six cycles of intra-uterine insemination with controlled ovarian hyperstimulation or six cycles of Modified Natural Cycle (MNC) IVF or three cycles with IVF-elective Single Embryo Transfer (eSET) plus cryo-cycles within a time frame of 12 months. Couples with unexplained subfertility or mild male subfertility and a poor prognosis for treatment independent pregnancy will be included. Women with anovulatory cycles...

Acute infectious morbidity in multiple gestation.

Dotters-Katz, SK; Patel, E; Grotegut, CA; Heine, RP
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Artigo de Revista Científica Formato: 173261 - ?
Publicado em //2015 ENG
Relevância na Pesquisa
46.14%
OBJECTIVES: Physiologic and immunologic changes in pregnancy result in increased susceptibility to infection. These shifts are more pronounced in pregnancies complicated by multiple gestation. The objective of this study was to determine the association between multiple gestation and risk of infectious morbidity. STUDY DESIGN: The Nationwide Inpatient Sample for the years 2008-2010 was used to identify pregnant women during admission for delivery with International Classification of Diseases codes. Logistic regression was used to compute odds ratios and 95% confidence intervals for demographic data, preexisting medical conditions, and acute medical and infectious complications for women with multiple versus singleton gestations. RESULTS: Among women with multiple gestation, 38.4 per 1,000 women had an infectious complication compared to 12.8 per 1,000 women with singletons. The most significant infectious morbidity associated with multiple gestation was intestinal infections, pyelonephritis, influenza, and pneumonia. After controlling for confounding variables, infectious complications at delivery persisted for women with multiples, though the association was dependent on mode of delivery. CONCLUSIONS: Women with multiple gestations are at increased risk for infectious morbidity identified at the time of delivery. This association was diminished among women who had a cesarean suggesting that operative delivery is not responsible for this association.