Outcomes in twin pregnancies reduced to singleton pregnancies compared with ongoing twin pregnancies

Gupta, Simi; Fox, Nathan S.; Feinberg, Jessica; Klauser, Chad K.; Rebarber, Andrei

doi:10.1016/j.ajog.2015.06.018

Cited by 31 publications

(39 citation statements)

References 11 publications

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“…Infant morbidity includes an increased risk of intrauterine growth restriction and preterm delivery with the associated complications of prematurity. Maternal morbidity includes an increased risk of hypertension, gestational diabetes, hemorrhage, and cesarean delivery [4,9]. Our results support single-embryo transfer to minimize the risks associated with multiple pregnancies.…”

Section: Discussionsupporting

confidence: 70%

Maternal and child-health outcomes in pregnancies following Assisted Reproductive Technology (ART): a prospective cohort study

Silva

Silveira

Bertoldi

et al. 2020

BMC Pregnancy Childbirth

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Background: Studies comparing the outcome of spontaneous versus assisted reproductive technologies (ART) pregnancies report heterogeneous results. Despite the success of ART to overcome infertility, concern is growing regarding both its safety and its effect on maternal and child health. The objective of this study was to compare maternal and child-health outcomes after ART relative to natural conception. Methods: A population-based birth cohort study was carried out among pregnant women expected to deliver in 2015 in Pelotas, southern Brazil. Maternal outcomes included pregnancy complications and gestational weight gain. Gestational age, weight, intrauterine growth restriction, length and head circumference, and 1-min and 5-min Apgar, as well as health problems at birth and breastfeeding were defined as offspring outcomes. Statistical analyses were performed using linear and logistic regression. G-formula was used to perform mediation analysis. Results: The study included 4252 babies born by spontaneously pregnancies and 23 babies born after ART. Adjusted analyses showed that children conceived from ART presented lower means of gestational age (p = 0.001), birth weight (p = 0.002), length (p < 0.001), and head circumference at birth (p = 0.02). However, more than 90% of the effect of ART over these outcomes was mediated by multiple pregnancy. Conclusion: Our findings suggest that the possible negative effect on the child-health outcomes is due mainly to the higher incidence of multiple pregnancies and not because of ART. The reasons for the increase in adverse pregnancy outcomes associated with ART singleton pregnancies are still uncertain and warrants further research. Further large-population studies are needed to confirm these results.

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Section: Discussionsupporting

confidence: 70%

Maternal and child-health outcomes in pregnancies following Assisted Reproductive Technology (ART): a prospective cohort study

Silva

Silveira

Bertoldi

et al. 2020

BMC Pregnancy Childbirth

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“…The risk of subsequent twin preterm birth is significantly higher after previous preterm singleton delivery compared with a previous term singleton delivery . SF in twins decreased both the risk of spontaneous preterm delivery at less than 37 weeks and of infant birth weight less than the 10th percentile in comparison with in continued twin pregnancies . SF in twin pregnancies is not always recommended, but to achieve the goal of having a healthy baby born at term to a healthy mother, it may be considered with strict criteria indications.…”

Section: Discussionmentioning

confidence: 99%

Transabdominal selective feticide in dichorionic twins: Ten years’ experience at a single center

Kim

Kang

et al. 2018

J of Obstet and Gynaecol

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Aim: The present study investigates the procedure-related fetal loss rate and obstetrical outcomes of selective feticide in dichorionic twins. Methods: We retrospectively analyzed the data of 44 cases of dichorionic twins. Two different indications for selective feticide were set: (i) the presence of genetic or congenital anomaly; and (ii) an obstetrical indication specified as a past maternal history of preterm delivery that caused fetal death or cerebral palsy of the child. Primarily, data on procedure-related fetal loss and obstetrical outcomes were retrieved. Additionally, data on obstetrical outcomes by reduction time and by indication of SF were obtained. Results: Selective feticide was performed in 44 casesspecifically, in 23 cases with genetic or congenital anomaly and in 21 cases with obstetrical indications. The median gestational age at delivery was 38 + 4 weeks. One pregnancy loss (2.3%, 1/44) occurred within 4 weeks after the procedure. The overall pregnancy loss rate throughout the pregnancy term was 2.3% (1/44). When selective feticide was performed at 15 weeks and beyond, the birth weight was significantly decreased compared with when selective feticide was performed earlier than 15 weeks. Conclusion: Transabdominal ultrasound-guided selective feticide in dichorionic twins is an effective and safe procedure. If a patient desires to maximize her chances of having a healthy child and decrease the risk of prematurity, the option of selective feticide should be considered in certain cases of twin pregnancies. Selective feticide may be a reasonable alternative to expectant management or termination of the whole twin pregnancy.

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“…MFPR of healthy DCDA twins to singleton confers a reduction in late preterm birth and a non-significant risk reduction of birth before 34 weeks of gestation. 47 Therefore, in DCDA twins, the balance of benefit in perinatal morbidity versus the risk of the invasive procedure is unclear. Some obstetricians may feel that such MFPR is not clinically justifiable under any of the grounds of current UK law.…”

Section: Ethical and Psychological Considerationsmentioning

confidence: 99%

Multifetal pregnancy reduction and selective termination

Beriwal

Impey

Ioannou

2020

The Obstetric & Gynaecologis

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Multifetal pregnancy reduction (MFPR) and selective termination (ST) are conceptually different procedures. Essential prerequisites for delivering these interventions are detailed counselling, multidisciplinary input within a tertiary fetal medicine service, careful choice of operative technique and appropriate gestational age, depending on the type of pregnancy and indication. Operative techniques that may be used are chemical, thermal, radiofrequency and laser, depending on chorionicity as well as other factors. Intracardiac potassium chloride is appropriate to employ when there is independent chorionicity and carries a lower risk of pregnancy loss; vascular occlusion using radiofrequency ablation, bipolar coagulation or intrafetal laser can be employed in monochorionic fetuses and twin reversed arterial perfusion pregnancies, but carry a higher risk of pregnancy loss. Women struggle with decision-making, particularly with fetal reduction, and should be supported with frank discussion of the risks, but also emotionally: the need for emotional and psychological support may long outlast the pregnancy. Learning objectives To know the differences between first trimester MFPR, second trimester cord occlusion and third trimester ST. To understand that MFPR is an intervention to reduce preterm birth-related disability in high-order multifetal pregnancies. To understand procedural outcomes and complications of MFPR and ST to enable adequate planning for subsequent obstetric care. Ethical issues The decision to undergo ST to improve the chances of survival of one fetus over another may have consequences on the parental project and the grieving process. Ethical questions are raised when MFPR occurs following in vitro fertilisation in which more than two embryos were intentionally transferred. In uncomplicated twin pregnancies, MFPR to singleton may reduce the risk of late preterm birth, but the benefit in long-term outcomes is less clear.

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Outcomes in twin pregnancies reduced to singleton pregnancies compared with ongoing twin pregnancies

Cited by 31 publications

References 11 publications

Maternal and child-health outcomes in pregnancies following Assisted Reproductive Technology (ART): a prospective cohort study

Maternal and child-health outcomes in pregnancies following Assisted Reproductive Technology (ART): a prospective cohort study

Transabdominal selective feticide in dichorionic twins: Ten years’ experience at a single center

Multifetal pregnancy reduction and selective termination

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