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Multiple Gestations
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Edward J. Hayes, Michelle R. Hayes
Multiple gestation is a gestation carrying >1 fetus. The overwhelming majority are twins. There are two types of twins:Monozygotic (MZ) twins are formed when a single fertilized ovum splits into two individuals who are almost always genetically identical, unless after their division a there is a spontaneous mutation.Dizygotic (DZ) twins are formed when two separate ova are fertilized by two different sperm resulting in genetically different individuals.
Conceiving Ethics
Published in Michael van Manen, The Birth of Ethics, 2020
With medical innovation, at times we can overcome infertility. Many different assisted reproductive technologies are available: ovulation induction, in vitro fertilization (IVF), artificial insemination, intracytoplasmic sperm injection, and so forth. And yet, achieving pregnancy with such means poses risks. Multiple gestation pregnancies (twin, triplet, and so forth) while being associated with assisted reproductive technologies are also associated with preterm birth that carries its own complications (Kushnir et al., 2017; Sunderam et al., 2019). Even when precautions are taken to mitigate the risks of conceiving a multiple gestation pregnancy (such as single- rather than multiple-embryo transfer), preterm birth and congenital anomalies remain present as risks (Liberman et al., 2017). In other words, assisted reproduction would seem to demand we accept risks for a child even before we conceive him or her. What worry should we have when we knowingly place a child at risk in our efforts to conceive him or her? Should this future child not be first and foremost in our mind even before attempts at conception? Is this not the ethical imperative of conception?
Pregnancy and Childbirth
Published in Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson, Health Care Needs Assessment, 2018
Jane Henderson, Leslie L. Davidson, Jean Chappie, Jo Garcia, Stavros Petrou
A greater proportion of multiple gestation pregnancies have adverse clinical outcomes than of singleton pregnancies. These will inevitably have significant resource implications for the health service and the wider economy. Multiple gestation pregnancies carry a significantly increased risk of maternal complications, including gestational diabetes, pregnancy-induced hypertension and caesarean delivery. They also carry a significantly increased risk of perinatal complications, including intrauterine growth restriction, premature delivery, intrauterine demise, low birthweight, and an increase in both short- and long-term medical and neurodevelopmental problems. In addition, multiple gestation pregnancies and births impose psychosocial and economic stresses on families. At the extreme end, this may lead to serious difficulties in daily living and marital discord and occasionally to child abuse, divorce and serious financial difficulties.
Substance-related diagnosis type predicts the likelihood and co-occurrence of preterm and cesarean delivery
Published in Journal of Addictive Diseases, 2023
Natasia S. Courchesne-Krak, María Luisa Zúñiga, Christina Chambers, Mark B. Reed, Laramie R. Smith, Jerasimos Ballas, Carla Marienfeld
Women with an International Classification of Diseases, 10th edition (ICD-10) code for a single live or stillbirth at ≥ 20 weeks of gestation were used for analysis (Table A in the supplemental material).13 Deliveries of multiple gestation were omitted due to potential differences in delivery outcomes related to more than one gestation. Data were collected from the antepartum (conception to ≤ 42 weeks) and intrapartum (labor and delivery) periods. When an individual record had more than one delivery carried to a gestational age of ≥ 20 weeks, each patient identification number (ID) and its unique delivery date represented one subject. The number of previous pregnancies for each delivery by ID number was identified by delivery codes that appeared before the most recent delivery in the dataset.
Is Uterine Myomectomy a Real Contraindication to Vaginal Delivery? Results from a Prospective Study
Published in Journal of Investigative Surgery, 2022
Marco La Verde, Luigi Cobellis, Marco Torella, Maddalena Morlando, Gaetano Riemma, Antonio Schiattarella, Anna Conte, Domenico Ambrosio, Nicola Colacurci, Pasquale De Franciscis
A comprehensive written informed consent form was signed by all included women before enrollment. We included primiparous patients with singleton gestations. During the study period, we followed and registered data of all women with a surgical history of laparoscopic or laparotomic myomectomy (group 1). Only singleton pregnancies that ended with the birth of a phenotypically healthy newborn at term (≥37 weeks’ gestation) were included. For the control group (group 2), we considered women without previous myomectomy who delivered in the same period in our hospitals. Exclusion criteria were as follows: multiparas and multiple pregnancies, stillbirths, patients with a medical indication for cesarean section, patients that received epidural analgesia and all pregnancies complicated by maternal or fetal pathologies (cigarette smoking, intrauterine growth restriction, pre-eclampsia/eclampsia, diabetes, multiple gestation pregnancies and major fetal defects). These exclusion criteria were chosen to reduce the bias between the two groups and to prevent confounding consequences on the number of maternal-fetal complications related to multiparity or other conditions.
Ocular disorders in children exposed in utero to buprenorphine
Published in Journal of Substance Use, 2021
Alane B. O’Connor, Liam M. O’Brien, Taunia Rifai, Georgia Ballem, Sarah Housman, Nathan Devore, Linda Schumacher-Feero
Unexposed subjects were chosen from a cohort of children treated in the same residency program who were not exposed to buprenorphine prenatally. When more than one potential match was identified for each child in the exposed group, the unexposed children were selected at random. We were unable to retrospectively determine a child’s insurance coverage at the time of birth but used current insurance type as a proxy. Children exposed to either perinatal methadone or other opioids during the course of the pregnancy were excluded from the unexposed group. If documentation in the chart raised a high index of suspicion for exposure to substance use during pregnancy, those children were also excluded. Exclusion criteria for both groups include birth prior to 37 weeks of gestation, multiple gestation status, birthweight of less than 2,500 grams and/or significant neonatal illness.