Twin Pregnancy and Severe Maternal Outcomes

Santana, Danielly S.; Cecatti, José Guilherme; Surita, Fernanda Garanhani; Silveira, Carla; Costa, Maria Laura; Souza, João Paulo; Mazhar, Syeda Batool; Jayaratne, Kapila; Qureshi, Zahida; Sousa, Maria Helena de; Vogel, Joshua P.

doi:10.1097/aog.0000000000001338

Cited by 112 publications

(50 citation statements)

References 23 publications

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“…Previous studies reported an incidence of PPH in multiple pregnancy in the range of 3.4–24% [23, 24]. In our study, there was a significantly higher rate of PPH secondary to uterine atony in the mothers in the DCC group.…”

Section: Discussionsupporting

confidence: 64%

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

et al. 2018

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Background: Delayed cord clamping (DCC) improves placental transfusion and increases blood volume in preterm infants when compared with immediate cord clamping (ICC). However, evidence to support DCC in multiple-birth preterm infants is still lacking. Objective: To compare the outcomes of ICC versus DCC in preterm infants of multiple births. Study Design: Women with a multiple pregnancy, including twins and triplets with a gestational age of 28–36 weeks, were randomized to receive ICC (23 women and 50 infants) or DCC for 30–60 s (24 and 51 infants). The infants’ hematocrit on admission, superior vena cava (SVC) flow measured within 24 h, and hematocrit at 8 weeks of age were compared. The use of uterotonic agents during delivery was not controlled in this study. Result: All infants were delivered by cesarean section (CS) except for 2 sets of twins, 1 in each group. Maternal and infant baseline characteristics in both groups were comparable. There were no significant differences between the groups in admission hematocrit, SVC flow measured within 24 h, hematocrit at 8 weeks of age, or any other neonatal outcomes. The incidence of maternal postpartum hemorrhage (PPH) was higher in the DCC group (4.3% in ICC vs. 25% in DCC, p = 0.04). Conclusion: DCC for 30–60 s did not improve placental transfusion or increase systemic blood flow in multiple-birth infants born preterm, mostly by CS, when compared with ICC. The finding of a higher PPH rate in the DCC group raises concerns about the maternal safety of this procedure in this patient population.

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Section: Discussionsupporting

confidence: 64%

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

et al. 2018

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“…However, our current understanding of the underlying metabolic mechanisms leading to suboptimal growth remains limited. Selective intrauterine growth restriction (sIUGR) is one of the most serious complications of monochorionic diamniotic (MCDA) twins with an incidence of 10–25% 2 – 4 . Compared with singleton intrauterine growth restriction (IUGR), sIUGR presents higher risks of adverse pregnancy and postpartum outcomes for both the mother and offspring 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Metabolic Biomarkers of Monochorionic Twins Complicated With Selective Intrauterine Growth Restriction in Cord Plasma and Placental Tissue

Wang

Han

Luo

et al. 2018

Sci Rep

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The selective intrauterine growth restriction (sIUGR) of monochorionic diamniotic (MCDC) twins causes phenotypic growth discordance, which is correlated with metabolomic pertubations. A global, untargeted identification of the metabolic fingerprint may help elucidate the etiology of sIUGR. Umbilical cord blood and placentas collected from 15 pairs of sIUGR monochorionic twins, 24 pairs of uncomplicated twins, and 14 singletons diagnosed with intrauterine growth restriction (IUGR) were subjected to gas chromatography-mass spectrometry based metabolomic analyses. Supervised multivariate regression analysis and pathway analysis were performed to compare control twins with sIUGR twins. A generalized estimating equation (GEE) model was utilized to explore metabolic differences within sIUGR co-twins. Linear logistic regression was applied to screen metabolites that significantly differed in concentration between control twins and sIUGR twins or IUGR singletons. Umbilical cord blood demonstrated better global metabolomic separation of sIUGR and control twins compared to the placenta. Disrupted amino acid and fatty acid metabolism as well as high levels of exposure to environmental xenobiotics were associated with sIUGR. The metabolic abnormalities in MCDA twins suggested that in utero growth discordance is caused by intrauterine and extrauterine environmental factors, rather than genetics. Thus, this study provides new therapeutic targets and strategies for sIUGR management and prevention.

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“…A total of 941 (88.6%) women who gave birth at MSCRH made at least one visit to an antenatal clinic and had laboratory procedures completed. In this study, a cut-off of <10 g/dl was used to define anaemia, which is one point below WHO standards (Santana et al, 2016). A total of 424 (45%) women had haemoglobin levels below the cut-off.…”

Section: Resultsmentioning

confidence: 99%

Descriptive analysis of effect of uptake of comprehensive antenatal care services on neonatal mortality, Kenya

Galgallo¹,

Roka

Boru

et al. 2019

African Journal of Midwifery and Women's Health

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Background Antenatal care services help decrease neonatal mortality. Laboratory profiling is a highly recommended part of antenatal care services, but it is often neglected. Aims To explore the importance of comprehensive antenatal care services in reducing neonatal mortality among births at Moyale Sub-County Referral Hospital in Kenya. Methods A retrospective review was conducted of maternity records of all women aged 15 years old or more who gave birth at Moyale Sub-County Referral Hospital between June 2014 and May 2015. Stillbirths were excluded from the analysis. Data were entered into Microsoft Excel and descriptive statistics calculated. A total of 1062 women were included in the study, with mean age of 24 ± 9.1 years. Of these, 11% had no antenatal care visits, 2% were HIV-positive, and all lived within 10 km of Moyale Sub-County Referral Hospital. Findings Children of women who had no antenatal care visits were 2.7 times more likely to die within 28 days of birth compared to children born to women who had 1 antenatal care visit, and 8.5 times more likely to die compared to women who had at least three antenatal care visits. Conclusions Antenatal care profiling helps reduce neonatal mortality by capturing early diagnosis of preventable conditions that affect birth outcomes.

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Twin Pregnancy and Severe Maternal Outcomes

Abstract: Twin pregnancy is associated with greater severe maternal morbidity and a higher rate of maternal death than singleton pregnancy.

Cited by 112 publications

References 23 publications

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

Metabolic Biomarkers of Monochorionic Twins Complicated With Selective Intrauterine Growth Restriction in Cord Plasma and Placental Tissue

Descriptive analysis of effect of uptake of comprehensive antenatal care services on neonatal mortality, Kenya

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