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PubMed2004

Overall prognosis with current treatment of infertility.

Few reports provide pregnancy or birth rates for large groups of infertile couples having a comprehensive range of treatments. This model utilizes published evidence about diagnosis, treatment, the duration of treatment and the proportion of couples receiving treatment. Assisted reproduction technology treatment (ART) utilization was set arbitrarily at three levels: 3, 10 or 50% of the couples that had no live birth after conventional treatment. For each diagnosis and treatment the model estimated total live births, singleton live births and multiple live births per 10,000 couples. The overall live birth rate with non-ART treatment would be 37%, involving 3,725 live births, of which 3,478 (93%) would be singleton and 247 (7%) would be multiple. With ART utilization at 3, 10 and 50% of couples with persistent infertility in each diagnostic category, live birth rates were 39, 43 and 47% respectively, with 8, 10 and 12% multiple births. The corresponding utilization of ART would be 244, 813 and 1481 ART cycles per 10(6) population per annum. Typical management of infertility would fall short of 50% live births even with extensive utilization of ART. Underlying unknown untreatable factors remain barriers to greater overall success in the treatment of infertility.

Birth Rate↗
PubMed1989

Incidence and some perinatal problems of multiple pregnancies in a central referral hospital, Addis Ababa.

This survey covers 41,645 deliveries registered in St. Paul's Hospital, Addis Ababa (one of the 6 central referral hospitals of Ethiopia), from 1971 to 1985, with multiple deliveries comprising 2.5% of all the cases. The results obtained from analysis of these data revealed that twins occurred in the ratio of 1:41 deliveries, and triplets in 1:41(2) deliveries, this is in conformity with Hellin's statement, made in 1895. The occurrence of multiple delivery in multigravidae is shown as 1.62 times greater than that in primigravidae. There was a male predominance (52.1%) among twins. Discordant twins and triplets were observed in 31.5% and 50% respectively. In 55.9% of twin deliveries, both twins had a birthweight of less than 2500g. Head presentation of both twins occurred in 40% of the multiple births. Operative delivery was undertaken in 12.4% of all the cases.

Diseases in Twins↗
PubMed2002

Breastfeeding higher order multiples: enhancing support during the postpartum hospitalization period.

Higher order multiple birth (HOM) families require genuine and effective support in their quest to breastfeed their infants during the postdelivery hospitalization period. Evidence suggests that the impact of current policies and care practices on HOM breastfeeding requires careful examination. Recommendations for enhanced support include evidence-based breastfeeding of multiples practices, multiples-specific breastfeeding education for HOM families and health professionals, and establishment of an HOM breastfeeding consultation network. Equally important are coordinated breastfeeding care, development of a breastfeeding plan in partnership with parents, avoidance or minimization of maternal-infants and infant-infants separations, and added assistance to parents when the infants' discharges are staggered. The recommendations are based on the author's extensive professional experience with HOM breastfeeding and the HOM literature.

Adult↗
PubMed1998

A model of litter size distribution in cattle.

Genetic increases in twinning of cattle could result in increased frequency of triplet or higher-order births. There are no estimates of the incidence of triplets in populations with genetic levels of twinning over 40% because these populations either have not existed or have not been documented. A model of the distribution of litter size in cattle is proposed. Empirical estimates of ovulation rate distribution in sheep were combined with biological hypotheses about the fate of embryos in cattle. Two phases of embryo loss were hypothesized. The first phase is considered to be preimplantation. Losses in this phase occur independently (i.e., the loss of one embryo does not affect the loss of the remaining embryos). The second phase occurs after implantation. The loss of one embryo in this stage results in the loss of all embryos. Fewer than 5% triplet births are predicted when 50% of births are twins and triplets. Above 60% multiple births, increased triplets accounted for most of the increase in litter size. Predictions were compared with data from 5,142 calvings by 14 groups of heifers and cows with average litter sizes ranging from 1.14 to 1.36 calves. The predicted number of triplets was not significantly different (chi2 = 16.85, df = 14) from the observed number. The model also predicted differences in conception rates. A cow ovulating two ova was predicted to have the highest conception rate in a single breeding cycle. As mean ovulation rate increased, predicted conception to one breeding cycle increased. Conception to two or three breeding cycles decreased as mean ovulation increased because late-pregnancy failures increased. An alternative model of the fate of ova in cattle based on embryo and uterine competency predicts very similar proportions of singles, twins, and triplets but different conception rates. The proposed model of litter size distribution in cattle accurately predicts the proportion of triplets found in cattle with genetically high twinning rates. This model can be used in projecting efficiency changes resulting from genetically increasing the twinning rate in cattle.

Animals↗
PubMedDate not supplied

Depression and anxiety disorders during multiple pregnancy and parenthood.

Depression or anxiety disorders may affect more than 25% of multiple birth parents during the perinatal period. Such parents often are uninformed, suffer in silence and fear, and are reticent to seek help. When depression, panic attacks, and obsessive-compulsive disorder are not recognized or are left untreated, parent health, parent-infants interaction, child development, and family stability may be seriously compromised. Nurses, as partners in care at the family and community levels, have a pivotal role to play in prevention-focused health, education, and social support programs; the identification of parents at risk; and the early recognition and support of women and families affected by these disorders.

Anxiety Disorders↗
PubMed1984

Single umbilical artery. A statistical analysis of 237 autopsy cases and review of the literature.

Two hundred thirty-seven autopsy cases of SUA and 1,242 unselected perinatal autopsies from military hospitals were reviewed and statistically analyzed. Results were correlated with those found in a comprehensive literature review. Incidence: The incidence of SUA in prospective deliveries is about 1%. Incidence is related to the portion of the umbilical cord examined, the method of cord examination (gross or microscopic), and to the race of the population base. The incidence of SUA in autopsy series is about twice the incidence in prospective series. SUA has a much higher incidence amont malformed, stillborn, or spontaneous abortuses than among apparently normal, liveborn, or induced abortuses. The incidence of SUA is less among very early embryos than among newborns because of the likelihood that SUA results from secondary atrophy of a preexisting normally formed second artery. As gestation proceeds, more cases will have become manifest to increase the incidence of SUA. There is no evidence of a familial tendency for SUA. SUA occurs slightly more frequently in females than in males, although there is a greater tendency for males with SUA to be malformed. The prognosis for SUA males is worse than for SUA females but no worse than that for male infants, in general. There is no relationship between the incidence of SUA and the month of the mother's last menstrual period. SUA and multiple births: The incidence of twins among SUA infants is at least three times greater than the overall incidence of twins. SUA occurs three to four times more frequently among twins than among Singletons. Although twin infants are subject to twice the expected incidence of malformations, twin SUA infants have no greater incidence of associated malformations than SUA singletons. Most SUA twins are discordant for the anomaly with SUA occurring in the smaller twin. The increased incidence of SUA among twin infants is not due to a greater incidence among monozygotic twins, since there is little difference from the usual proportion of monozygotic and dizygotic twins among twins with SUA. Mortality: In prospective series the mean perinatal mortality is about 20.0%. Approximately two-thirds of the perinatal deaths are stillborn and one-third are liveborn; and of the stillborn SUA infants, approximately three-quarters die antepartum and one-quarter die intrapartum. Mortality of SUA infants is related to associated fetal and placental malformations, prematurity and low birth weight, and intrauterine growth retardation. Although associated malformations are the primary cause of the high perinatal mortality, even nonmalformed SUA infants have an increased mortality rate.(ABSTRACT TRUNCATED AT 400 WORDS)

Abnormalities, Multiple↗
PubMed2004

Descriptive epidemiology of lipomyelomeningocele, Hawaii, 1986-2001.

BACKGROUND: The epidemiology of neural tube defects (NTDs) may depend on the type of the defect and its location. There is little epidemiologic information on lipomyelomeningocele, a type of NTD. The objective of this investigation was to describe the epidemiology of lipomyelomeningocele. METHODS: Cases were obtained from a Hawaii birth defect registry and consisted of all infants delivered during 1986-2001 with lipomyelomeningocele. Lipomyelomeningocele rates per 10,000 births were calculated for various factors. RESULTS: A total of 17 cases of lipomyelomeningocele were identified, for a total rate of 0.57. When the lipomyelomeningocele rate was examined with respect to the time period of folic acid fortification of cereal grains in the United States, the rate was 0.57 during 1986-1996 (prefortification), 0.57 during 1997-1998 (voluntary fortification), and 0.58 during 1999-2001 (mandatory fortification). A total of 11 (64.7%) of the cases were female. Lipomyelomeningocele rates were higher among infants born to mothers in younger and older age groups. The rate was highest among Pacific Islanders, followed by Filipinos and Far East Asians, and lowest among whites. Rates were greater with lower birth weight and gestational age and among multiple births. CONCLUSIONS: Lipomyelomeningocele rates were not found to be affected by folic acid fortification. The majority of cases were female. Other demographic and clinical factors appear to be associated with lipomyelomeningocele risk. None of the differences in rates between the various subgroups were statistically significant, and due to the small number of cases, the 95% confidence interval (CI) ranges were wide. However, the findings suggest possible patterns of occurrence. Additional studies involving larger numbers of cases are recommended.

Adult↗
PubMed2006

Labor dystocia and its association with interpregnancy interval.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of labor dystocia and its association with interpregnancy interval. STUDY DESIGN: We linked the birth data for Michigan infants who were born from 1994 to 2002 with the hospital discharge data. The International Classification of Diseases (9th revision, clinical modifications, ICD-9-CM) codes that indicate labor dystocia were identified by a physician panel and classified as functional and mechanical dystocia. We estimated the prevalence of labor dystocia and used stratified and logistic regression analyses to evaluate labor dystocia in relation to interpregnancy interval, controlling for other reproductive risk factors. RESULTS: Overall, 20.8% of the births involved labor dystocia (11.1% functional; 12.5% mechanical). Both functional and mechanical dystocia were more prevalent in first births than in subsequent births; mechanical dystocia was more prevalent in multiple births than in singleton births. In singleton births to multiparous mothers, labor dystocia was associated with the interpregnancy interval in a dose-response fashion. Compared with an interpregnancy interval of <2 years, the adjusted odds ratios that was associated with interpregnancy intervals of 2 to 3, 4 to 5, 6 to 7, 8 to 9, and 10+ years were 1.06 (95% CI, 1.04-1.08), 1.15 (95% CI, 1.12-1.17), 1.25 (95% CI, 1.21-1.29), 1.31 (95% CI, 1.26-1.37), and 1.50 (95% CI, 1.45-1.56), respectively, when we controlled for other reproductive risk factors. Functional dystocia was associated more strongly with interpregnancy interval than mechanical dystocia. CONCLUSION: Labor dystocia is common. In singleton births to multiparous mothers, labor dystocia increased with interpregnancy interval.

Adolescent↗
PubMed2002

The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions.

OBJECTIVE: This study was undertaken to determine the association between prenatal care in the United States and preterm birth rate in the presence, as well as absence, of high-risk pregnancy conditions for African American and white women. STUDY DESIGN: Data were derived from the natality data set for the years 1995 to 1998 provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred at >/=20 weeks' gestation. Multiple births, fetal deaths, congenital malformations, chromosomal abnormalities, missing data on gestational age, and birth weight less than 500 g were excluded. Multivariable logistic regression analyses were used to adjust for the presence or absence of various antenatal high-risk conditions, maternal age, gravidity, marital status, smoking, alcohol, and education. Prenatal care was considered present if there was one or more prenatal visits. Preterm delivery was defined as delivery at less than 37 completed weeks of gestation. RESULTS: For 14,071,757 births analyzed, 1,348,643 (9.6%) resulted in preterm birth. Preterm birth rates were higher for African American women than white women in the presence (15.1% vs 8.3%) and absence (34.9% vs 21.9%) of prenatal care. The absence of prenatal care increased the relative risk for preterm birth 2.8-fold in both African American and white women. There was an inverse dose-response relationship between the number of prenatal visits and the gestational age at delivery both among African American and white women. Lack of prenatal care was associated with increased preterm birth rates to a similar degree in the presence of pregnancy complications for both African American and white women, ranging from 1.6-fold to 5.5-fold for the various antenatal high-risk conditions. CONCLUSION: In the United States, prenatal care is associated with fewer preterm births in the presence, as well as absence of high-risk conditions for both African American and white women. Strategies to increase prenatal care participation may decrease preterm birth rates.

Black or African American↗
PubMed1996

Adult sensory capacities as a function of birth risk factors.

This study examined the relationship between birth risk factors and sensory capacity in 1245 young adults (mean age = 19.9 years). Nine birth risk factors were included (long labour, breech birth, breathing difficulty, instrument delivery, Caesarian delivery, multiple birth, premature birth, low birth weight, and high-risk birth order) and six sensory capacities were tested (Snellen visual acuity, stereopsis, color discrimination, pure-tone hearing, speech recognition, and sound localization). Mild birth stressors were strongly predictive of reduced visual acuity and stereoscopic discrimination, and mildly predictive for the other sensory measures. The fact that vision was more vulnerable to the effects of birth stress than audition may be due to the slower maturation of the visual system. Of the birth stressors examined, twinning was found to have the largest effect on sensory function, possibly because it often occurs conjointly with other birth stressors such as low birth weight, breech presentation, and breathing difficulty and may involve the use of birthing instruments such as forceps.

Adolescent↗
PubMed2004

Perinatal Care in Canada.

HEALTH ISSUE: Canada's standard of perinatal care ranks among the highest in the world, but there is still room for improvement, both in terms of regional differences in care and global comparisons of approaches to care in Canada and elsewhere. Data from the Canadian Perinatal Surveillance System (CPSS) was used to evaluate morbidity and mortality among mothers and infants. KEY FINDINGS: Maternal mortality rates in Canada dropped to 4.4 per 100,000 live births in 1993-1997 and are among the lowest in the world. Rates of Caesarean section increased from 15.3 per 100 deliveries in 1994 to 19.1 in 1997. Although the infant mortality rate in Canada is among the lowest in the world (5.3-8.8 per 1,000 live births 1990-2000), there are unacceptable disparities between subpopulations. In Aboriginal populations, rates of stillbirth and perinatal mortality are 2-2.5 times the Canadian average. There has been a steady increase in the proportion of births among older women who have the highest risk of preterm births and pregnancy complications.The increasing rate of multiple births has accelerated recently and is of concern as these carry a higher risk of complications and are associated with an increased risk of preterm birth. The costs to the health care system are likely to be high. DATA GAPS AND RECOMMENDATIONS: CPSS data, including economic indicators, needs to be collected in a more timely and uniform manner across Canada. The CPSS should provide an evaluation of how well Canada fares in relation to international standards of perinatal care.

Journal Article↗
PubMed2003

A population-based study of inflicted traumatic brain injury in young children.

CONTEXT: Physical abuse is a leading cause of serious head injury and death in children aged 2 years or younger. The incidence of inflicted traumatic brain injury (TBI) in US children is unknown. OBJECTIVE: To determine the incidence of serious or fatal inflicted TBI in a defined US population of approximately 230 000 children aged 2 years or younger. DESIGN, SETTING, AND SUBJECTS: All North Carolina children aged 2 years or younger who were admitted to a pediatric intensive care unit or who died with a TBI in 2000 and 2001 were identified prospectively. Injuries were considered inflicted if accompanied by a confession or a medical and social service agency determination of abuse. MAIN OUTCOME MEASURE: Incidence of inflicted TBI. Multivariate logistic regression models were used to compare children with inflicted injuries with those with noninflicted injuries and with the general state population aged 2 years or younger. RESULTS: A total of 152 cases of serious or fatal TBI were identified, with 80 (53%) incurring inflicted TBI. The incidence of inflicted traumatic brain injury in the first 2 years of life was 17.0 (95% confidence interval [CI], 13.3-20.7) per 100 000 person-years. Infants had a higher incidence than children in the second year of life (29.7 [95% CI, 22.9-36.7] vs 3.8 [95% CI, 1.3-6.4] per 100 000 person-years). Boys had a higher incidence than girls (21.0 [95% CI, 15.1-26.6] vs 13.0 [95% CI, 8.4-17.7] per 100 000 person-years). Relative to the general population, children who incurred an increased risk of inflicted injury were born to young mothers (< or =21 years), non-European American, or products of multiple births. CONCLUSIONS: In this population of North Carolina children, the incidence of inflicted TBI varied by characteristics of the injured children and their mothers. These data may be helpful for informing preventive interventions.

Age Factors↗
PubMed2004

The origins and outcomes of triplet and quadruplet pregnancies in Nova Scotia: 1980 to 2001.

The objective of this study was to determine the rate, origin, maternal and perinatal outcomes, and the associated hospital costs of higher order multiple births in one Canadian province. All higher order multiple pregnancies (triplets and above) in Nova Scotia over a 22-year period (1980 to 2001) were reviewed, and the maternal and perinatal outcomes and hospital costs were compared with singletons and twins in the same hospital population. During the 22-year period, 116,785 infants were delivered, including 3448 twins, 99 triplets, and 16 quadruplets. Of the higher order multiple gestations, 51.4% were conceived through infertility therapy. When compared with mothers of either singletons or twins, mothers of higher order gestations were significantly older, had longer antepartum and postpartum hospital stays, were more likely to have cesarean delivery, preterm labor, preeclampsia, and require intensive care unit admission. Triplets and quadruplets had significantly higher rates of preterm delivery, major anomalies, neonatal intensive care, respiratory distress syndrome, intrauterine growth restriction, serious morbidity, 5-minute Apgar scores < or = 3, and neonatal death than twins or singletons. The estimated hospital costs for this population ranged from 6,750 US dollars for a singleton pregnancy to 278,400 US dollars for a quadruplet pregnancy. Maternal morbidity, perinatal morbidity and mortality, and hospital costs are significantly increased in higher order births compared with both twins and singletons.

Adult↗
PubMedDate not supplied

[Birth weight discordance and perinatal mortality among triplets].

INTRODUCTION: The incidence of multiple births has increased in the last decade. Perinatal mortality in triplets is significantly greater than in twin and singleton births. OBJECTIVE: The objective of this study was to describe the extent of birth weight discordance among triplets and to identify its association with an increased risk of perinatal mortality. METHOD: A retrospective analysis of triplet births, for the period 1993-2003, was conducted at the Gynaecological-Obstetric Clinic "Narodni Front" in Belgrade. Birth weight discordance was defined as the difference in birth weight between the largest and the smallest triplet's weight of more than 20%. RESULTS: The rate of triplets has increased by almost 75% between the first (7.7%) and the last (29.6%) 5-year period of the last decade. Triplets are becoming more common because of the frequent use of assisted reproductive technology as a treatment for infertility. In the period 1993-2003, there were a tota of 40 triplet live births (24 weeks and greater) with incidence of 0.06%. There was no clear association between maternal age, parity, method of conception, birth gestational age, and disorders complicating pregnancy with birth discordance more than 20%. Regarding birth weight groups, statistical significance occurred only in the < 999 grams group for discordant and in the 2000-2499 grams group for concordant triplets. Overall, the perinatal mortality rate in the group was 10.8%, the foetal mortality rate was 1.7% (2/120), and the neonatal (0-28 days) mortality rate was 9.1% (11/120). An odds ratio of 95% confidence interval shows 3 times greater risk for adverse perinatal outcome in the discordant group. However, the difference was not significant. CONCLUSION: Increasing birth weight discordance may increase the risk of adverse perinatal outcome. Triplet pregnancies, being high risk, require intensive antenatal care in order to prevent preterm delivery and ultrasound in order to diagnose foetal growth abnormality and discordance, which increase foetal surveillance, through the use of biophysical profiles, non stress tests, and Doppler velocimetry, thus assessing foetal well being and the appropriate moment for obstetric intervention.

Adult↗
PubMed2006

A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility.

BACKGROUND: Controlled ovarian hyperstimulation with intrauterine insemination (IUI) is a widely accepted treatment for unexplained and male subfertility. No consensus exists about the drug of first choice to be used as hyperstimulation. This randomized multicentre trial using a parallel design compares the efficacy of clomiphene citrate (CC) with that of recombinant FSH (rFSH). METHODS: Couples with primary unexplained or male subfertility were randomized to receive CC or rFSH for ovarian hyperstimulation. The treatment was continued for up to four cycles unless pregnancy occurred. Cycles with more than three follicles were cancelled. Cumulative pregnancy rates and live birth rates were primary outcomes. Cancellation during treatment and multiple birth rates are secondary outcomes. Results were analysed following the intention-to-treat principle. RESULTS: Seventy couples with male subfertility and 68 couples with unexplained subfertility were included. Seventy-one women received CC, and 67 received rFSH. Twenty-seven pregnancies were observed in the CC group (38%) and 23 in the rFSH group (34.3%) relative risk (RR) 1.11 [95% confidence interval (95% CI) 0.71-1.73]. The live birth rate was 28.2% (20/71) and 26.9% (18/67) for CC and rFSH, respectively, RR 1.05 (95% CI 0.61-1.80). Overall, the live birth rates per cycle were 10% for CC-stimulated and 8.7% for rFSH stimulated cycles. The total multiple pregnancy rate was 6.0%. Thirty-five cycles (8.6%) were cancelled because of four or more follicles (CC, n = 17; rFSH, n = 18). CONCLUSIONS: In couples with primary unexplained or male subfertility participating in an IUI program, ovarian hyperstimulation can be achieved by CC or rFSH. No significant difference in live birth rates between CC and rFSH was observed. Being less expensive, CC seems the more cost-effective drug and therefore, can be offered as drug of first choice.

Adult↗
PubMed2002

Physical status of newborns and neonatal outcome.

OBJECTIVE: To determine the extent to which physical status at birth is associated with neonatal mortality and the causes of mortality vis-a-vis size at birth and gestational age. METHOD: 11,223 consecutive live births completing 26 weeks of gestation and weighing > or = 500 gm were included in the study. Birth weight and chest circumference were recorded as per WHO guidelines. Gestational age was calculated on the basis of L.M.P. and the new Ballard's score. Deaths occurring in the hospital within 28 days were recorded. Percentile values of gestational age specific birth weights were calculated separately for singletons and multiple births. Percentage of SGA was calculated with reference to WHO recommended values. Birth weight-gestational age-specific mortality rates were calculated at 2 wk and 500 gm intervals. RESULT: Low-birth-weight babies constituted 39.8% of the total, much in excess of WHO recommended figure of 15%. 76% deaths occurred among LBW babies and 56.2% among preterms. Mortality showed remarkable decline as the birth weight increased to 2,000 gm. The lowest mortality was among singletons weighing 2,500-3,000 gm and of 38-40 weeks gestation. Prevalence of SGA at 40 and 42 weeks were 73.7% and 83.6% respectively. But, if SGA babies not categorised as LBW were excluded, the values came down to 32% and 36% respectively. 36% of all deaths occurred during the first 24 hrs of birth; asphyxia and related causes contributing to 50% of it. CONCLUSION: Cut-off value of 2,000 gm instead of 2,500 gm for birth weight may be preferable in countries where most LBW babies are SGAs. Simultaneously, deaths in non-LBW babies due to perinatal causes contribute sgnificantly to total neonatal mortality and need due attention through sensitising obstetricians in essential newbom care and timely Intervention.

Birth Weight↗
PubMed1979

EEC Concerted Action Project--European Congenital Anomalies and Twins (Eurocat).

The European Economic Community (EEC) is promoting a network of locally funded centers in the nine EEC countries, surveying a total of approximately 140,800 births per year for selected congenital malformations and multiple births. The objectives and aims of the study are explained and some of the methods to set guidelines detailed.

Congenital Abnormalities↗
PubMed2003

Maternal and neonatal factors influencing premature birth and low birth weight in Australia.

This study identified the influences of neonatal and maternal factors on premature birth and low birth weight in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected neonatal and maternal characteristics with premature birth and low birth weight. The findings of this study showed that premature birth and low birth weight rate significantly varied by infant sex, maternal age, marital status, Aboriginality, parity, maternal smoking behaviour during pregnancy and maternal hypertension. First-born infants, and infants born to mothers aged less than 20 years, or who were single, separated/divorced, Aboriginal or who smoked during the pregnancy, were at increased risk of being premature or of low birth weight. This study also found that risk factors for premature births and low birth weight were similar in both singleton and multiple births. Gestational age was confirmed to be the single most important risk factor for low birth weight. The findings of this study suggest that in order to reduce the incidence of low birth weight and premature births, health improvement strategies should focus on anti-smoking campaigns during pregnancy and other healthcare programmes targeted at the socially disadvantaged populations identified in the study.

Adolescent↗