Epidemic of plurality and contributions of assisted reproductive technology therein

Kapoor, Monica; Pal, Lubna

doi:10.1002/ajmg.c.30205

Cited by 4 publications

(2 citation statements)

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“…We had no information on chorionicity or use of assisted reproductive technologies, which are known to have a significant impact on fetal and neonatal outcomes. [23] Our analysis did not explore interaction of variables or effect modification. As a descriptive analysis of deliveries in larger, referral facilities in LMICs, these results cannot be generalised to women in community settings or to those delivering at home, which in some African countries represents more than half of all deliveries.…”

Section: Discussionmentioning

confidence: 99%

Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries

et al. 2013

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BackgroundTwin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources. We conducted a secondary analysis of the WHO Global Survey dataset to analyze maternal and perinatal outcomes in twin pregnancies and factors associated with perinatal morbidity and mortality in twins.MethodsWe examined maternal and neonatal characteristics in twin deliveries in 23 LMICs and conducted multi-level logistic regression to determine the association between twins and adverse maternal and perinatal outcomes.Results279,425 mothers gave birth to 276,187 (98.8%) singletons and 6,476 (1.2%) twins. Odds of severe adverse maternal outcomes (death, blood transfusion, ICU admission or hysterectomy) (AOR 1.85, 95% CI 1.60–2.14) and perinatal mortality (AOR 2.46, 95% CI 1.40–4.35) in twin pregnancies were higher, however early neonatal death (AOR 2.50, 95% CI 0.95–6.62) and stillbirth (AOR 1.22, 95% CI 0.58–2.57) did not reach significance. Amongst twins alone, maternal age <18, poor education and antenatal care, nulliparity, vaginal bleeding, non-cephalic presentations, birth weight discordance >15%, born second, preterm birth and low birthweight were associated with perinatal mortality. Marriage and caesarean section were protective.ConclusionsTwin pregnancy is a significant risk factor for maternal and perinatal morbidity and mortality in low-resource settings; maternal risk and access to safe caesarean section may determine safest mode of delivery in LMICs. Improving obstetric care in twin pregnancies, particularly timely access to safe caesarean section, is required to reduce risk to mother and baby.

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Section: Discussionmentioning

confidence: 99%

Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries

et al. 2013

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“…Assisted reproductive technology (ART) has been associated with an epidemic of multiple pregnancies. 1 Increasing awareness of the risks posed by higher order multiple pregnancies has led to recommendations and legislation limiting the number of embryos being transferred. 2 The availability of efficient cryopreservation techniques has also obviated the need to transfer multiple embryos in a fresh cycle by enabling cryopreservation of supernumerary good quality embryos which could be sequentially transferred in frozen cycles.…”

Section: Introductionmentioning

confidence: 99%

Monozygotic Pregnancies Following Assisted Reproductive Technology: A Review

Mascarenhas

Gnanaprabha

2016

EMJ Repro Health

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Introduction: Assisted reproductive technology (ART) is associated with an increased risk of monozygotic twinning. This narrative review attempts to summarise the known literature regarding the aetiology, incidence, risk factors, diagnosis, and prognosis of monozygotic twinning following ART. Aetiology: Monozygotic twinning is caused by the splitting of the early embryo during the peri-implantation phase. According to the classical hypothesis, the timing of the split determines the chorionicity and amnionicity, however this has been questioned in recent literature. Incidence and risk factors: The incidence of monozygotic twinning in natural conception appears to be independent of extrinsic factors such as ethnicity and age. The incidence of monozygotic twinning is increased from 0.4% of natural conceptions to around 0.9–2.24% of pregnancies following ART. The available literature supports a role of ovarian stimulation and extended culture to the blastocyst stage in increasing the risk of monozygotic twinning. The impact of maternal age and micromanipulation techniques such as assisted hatching and intra-cytoplasmic sperm injection appear to depend on the stage of the embryo being transferred leading to significant heterogeneity between studies. Diagnosis: The gold standard for diagnosing monozygotic twinning is genetic testing but its cost precludes it from routine widespread use. Most epidemiological studies utilise statistical estimates such as Weinberg’s differential rule and tailored questionnaires. Most studies from ART units have utilised transvaginal sonography for counting the number of gestational sacs or assessing the chorionicity. Prognosis: The prognosis of twins appears to be dependent on the chorionicity and amnionicity and is largely independent of the zygosity.

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Twins

Murdoch¹,

Smith²

2012

Rennie &Amp; Roberton's Textbook of Neonatology

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Epidemic of plurality and contributions of assisted reproductive technology therein

Abstract: A commentary on contributions of ART to the pandemic of multiple gestations is presented and mechanistic aspects therein are explored.

Cited by 4 publications

References 75 publications

Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries

Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries

Monozygotic Pregnancies Following Assisted Reproductive Technology: A Review

Twins

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