Systematic management of twin pregnancies to reduce pregnancy complications

Gao, Li; Lyu, Shu-Ping; Zhao, Xin; Wu, Yi Chia; Hua, Renyi; Wang, Shan; Zhang, Yan; Wang, Yanlin

doi:10.1097/cm9.0000000000000808

Cited by 6 publications

(4 citation statements)

References 5 publications

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“…Even intense exercise in a rare case of a competitive marathon runner pregnant with twins had no adverse effects on either maternal or infant outcomes [ 31 ]. Furthermore, systematic management including physical activity counselling for individuals with twin pregnancies did not increase the risk of premature delivery and may reduce the risk of postpartum hemorrhage [ 32 ]. These positive previous reports, although underpowered, suggest that individuals with multifetal pregnancy can benefit from maintaining physical activity during gestation.…”

Section: Discussionmentioning

confidence: 99%

Physical Activity Behaviors and Barriers in Multifetal Pregnancy: What to Expect When You’re Expecting More

Meah

Strynadka

Khurana

et al. 2021

IJERPH

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The health benefits of prenatal physical activity (PA) are established for singleton pregnancies. In contrast, individuals with multifetal pregnancies (twins, triplets or more) are recommended to restrict or cease PA. The objectives of the current study were to determine behaviors and barriers to PA in multifetal pregnancies. Between 29 May and 24 July 2020, individuals with multifetal pregnancies participated in an online survey. Of the 415 respondents, there were 366 (88%) twin, 45 (11%) triplet and 4 (1%) quadruplet pregnancies. Twenty-seven percent (n = 104/388) of respondents completed no PA at all during pregnancy, 57% (n = 220/388) completed PA below current recommendations, and 16% (n = 64/388) achieved current recommendations (150-min per week of moderate-intensity activity). Most respondents (n = 314/363 [87%]) perceived barriers to PA during multifetal pregnancy. The most prominent were physical symptoms (n = 204/363 [56%]) and concerns about risks to fetal wellbeing (n = 128/363 [35%]). Sixty percent (n = 92/153) felt that these barriers could be overcome but expressed the need for evidence-based information regarding PA in multifetal pregnancy. Individuals with multifetal pregnancies have low engagement with current PA recommendations but remain physically active in some capacity. There are physical and psychosocial barriers to PA in multifetal pregnancy and future research should focus on how these can be removed.

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Section: Discussionmentioning

confidence: 99%

Physical Activity Behaviors and Barriers in Multifetal Pregnancy: What to Expect When You’re Expecting More

Meah

Strynadka

Khurana

et al. 2021

IJERPH

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“…Compared with singleton pregnancies, twin pregnancies have a higher risk of PPH. Hence, the perinatal management of twin pregnancies needs to receive high priority (3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Nomogram to predict postpartum hemorrhage in cesarean delivery for twin pregnancies: a retrospective cohort study in China

et al. 2023

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BackgroundPostpartum hemorrhage (PPH) is the most common cause of maternal morbidity and mortality worldwide. A reliable risk assessment tool for PPH could optimize available interventions to reduce adverse maternal outcomes.ObjectiveThe objective of this study was to explore a nomogram predicting the risk of postpartum hemorrhage after cesarean delivery for twin pregnancies.MethodsThis single-center retrospective cohort study conducted twin pregnancies who underwent cesarean delivery between January 2014 and July 2021. Propensity score matching at baseline was used to match PPH (blood loss ≥1000 mL) and non-PPH group (blood loss <1000 mL). A nomogram was developed to predict the risk of PPH in cesarean delivery for twin pregnancies. The receiver operating characteristic curve (ROC), calibration plot, and decision curve analysis (DCA) were, respectively, used to evaluate the discrimination, calibration, and clinical utility of the prediction models.ResultsAfter propensity score matching, 186 twin pregnancies in the PPH group were matched with 186 controls in the non-PPH group. Seven independent prognostic variables, including antepartum albumin, assisted reproductive technology, hypertensive disorders of pregnancy, placenta previa, placenta accrete spectrum, intrapartum cesarean delivered, and estimated weights of twins, were used to build the nomogram. Based on the performance of the model, it appears that a good calibration (Hosmer–Lemeshow χ2 = 4.84, P > 0.05), an excellent predictive ability (area under the curve: 0.778, 95% CI: 0.732–0.825), and a good positive net benefit in the predictive model have been achieved.ConclusionThe nomogram was first generated to predict PPH in cesarean delivery for twin pregnancies, which could help clinicians to provide a reference for the preoperative surgical plan, choose optimal treatments, optimize healthcare resources, and thereby reduce the associated adverse maternal outcomes.

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“…According to the literature, multiple pregnancies are associated with an increased risk of mortality compared to single fetal pregnancies. [ 1 , 2 ] In this sense, multifetal pregnancies represent 3% of pregnancies, of which 98% are twins, more frequently exposed to the phenomenon of premature birth, and 10% of them are stillbirths. [ 3 ] Identifying the causes of neonatal morbidity and mortality is essential for planning its reduction since respiratory diseases are the biggest contributor to morbidity and mortality in premature and low-birth-weight infants.…”

Section: Introductionmentioning

confidence: 99%

Surfactant proteins analysis in perinatal deceased preterm twins among the Romanian population

et al. 2022

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The molecular basis of the evaluation of children suspected of having disorders of surfactant proteins is still under discussion. In this study, we aimed to describe the morphological characteristics and to evaluate the immunohistochemical expression of surfactant proteins (surfactant protein A [SPA], surfactant protein B, and pro-surfactant protein C) in the preterm twins that deceased due to unexplained respiratory distress syndrome (n = 12). Results showed statistically significant positive correlations between surfactant protein B expressions and pulmonary hemorrhage (ρ = 0.678; P < .05), SPA levels, and Apgar score (ρ = 0.605; P < .05) and also expressions of SPA and bronchopneumonia (ρ = 0.695; P < .05). The fetuses and neonates of the same gestational age showed differences among surfactant proteins regarding the immunostaining expression. Our data evidence a marked interindividual variability in the expression of all 3 surfactant proteins among the cases analyzed (n = 12), suggesting the intervention of some individual and epigenetic factors during gestation that might influence surfactant protein production and consequently survival rate.Abbreviations: ELBW = extremely low birth weight, GA = gestational age, PI = ponderal index, RDS = respiratory distress syndrome, SPA = surfactant protein A, SPB = surfactant protein B, SPC = surfactant protein C, SPD = surfactant protein D.

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Systematic management of twin pregnancies to reduce pregnancy complications

Cited by 6 publications

References 5 publications

Physical Activity Behaviors and Barriers in Multifetal Pregnancy: What to Expect When You’re Expecting More

Physical Activity Behaviors and Barriers in Multifetal Pregnancy: What to Expect When You’re Expecting More

Nomogram to predict postpartum hemorrhage in cesarean delivery for twin pregnancies: a retrospective cohort study in China

Surfactant proteins analysis in perinatal deceased preterm twins among the Romanian population

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