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PubMed2005

Changes in twinning rates in South Korea: 1981-2002.

The present study investigates the twinning rate trends in South Korea for the years 1981 to 2002 utilizing the birth record data from the South Korea National Statistical Office. The twinning rates between 1981 and 1991 remained nearly constant and were slightly less than 10 twin individuals, that is, approximately five pairs per thousand births. Since the early 1990s, however, the twinning rate has increased sharply and reached 19.30 twin individuals, that is, around 10 pairs per thousand births in the year 2002. Application of the Weinberg method to birth data for the years 2000 to 2002 revealed that the dizygotic twin rate in South Korea increased almost threefold between 1981 to 1991 and 2002. In the 1980s the effect of maternal age on twinning rates appeared to be minimal. In the 1990s, however, increases in twinning rates occurred more markedly among older mothers than among younger mothers. We speculate that the rapid rise in twinning rates in South Korea in the 1990s is probably attributable to the spread of Assisted Reproductive Technologies among older mothers who seek treatments for infertility. The present study also examined whether residing in industrial areas is associated with multiple births in the South Korean population. The results did not support the recent finding of higher twinning incidence in industrialized regions.

Adult↗
PubMed2005

Descriptive epidemiology of anotia and microtia, Hawaii, 1986-2002.

The objective of this investigation was to describe the epidemiology of anotia and microtia with respect to various factors. The cases studied were all infants and fetuses with anotia or microtia identified by a population-based birth defects registry in Hawaii. The anotia and microtia rates were determined for selected factors and comparisons made among the subgroups by calculating the rate ratio (RR) and 95% confidence interval (CI). A total of 120 cases were identified, for a rate of 3.79 per 10,000 live births. The anotia and microtia rate increased during 1986-2002, although the trend was not significant (P = 0.715). Of 49 specific structural birth defects examined, four were found to be significantly more common in the presence of anotia and microtia. When compared with Caucasians, the anotia and microtia rates were higher among Far East Asians (RR 1.79, 95% CI 0.89-3.68), Pacific Islanders (RR 2.26, 95% CI 1.24-4.32), and Filipinos (RR 2.34, 95% CI 1.23-4.64). The defects were less common among females (RR 0.64, 95% CI 0.43-0.93) and more common with multiple birth (RR 3.72, 95% CI 1.66-7.33), birth weight < 2500 g (RR 3.35, 95% CI 2.04-5.30), and gestational age <38 weeks (RR 2.27, 95% CI 1.49-3.40). In conclusion, the rate for anotia and microtia increased in Hawaii during the study period. The rates for only a few structural birth defects were substantially greater than expected in association with anotia and microtia. Anotia and microtia rates varied significantly according to maternal race/ethnicity, infant sex, plurality, birth weight, and gestational age.

Adult↗
PubMed2003

[Towards a single embryo transfer: predictive value of uterine and embryological parameters in assisted reproduction outcome].

OBJECTIVE: The transfer of a single embryo would avoid obstetrical and neonatal complications due to multiple pregnancies. We studied the clinical value of both uterine and embryological parameters to define precise conditions allowing a single embryo transfer without decreasing pregnancy rates. PATIENTS AND METHODS: Endometrial parameters expressed by a uterine score together with biological criteria of 131 in vitro fertilization or intracytoplasmic sperm injection attempts were retrospectively analysed. RESULTS: Two hundred and sixty-two day-3 embryos were replaced through 131 transfers. Fifty-seven pregnancies were induced and 16 twins were obtained. The clinical pregnancy rate was 35.9% and the embryonic implantation rate 24.0%. After the transfer of two embryos, successful implantation was determined by the occurrence of top-quality embryos and simultaneously by a receptive endometrium. The uterine pulsatility index was significantly decreased for twin compared to singleton pregnancies. DISCUSSION AND CONCLUSION: This study confirms that a uterine score constitutes a powerful tool for evaluating the uterine receptivity. This parameter has to be taken into account as well as the embryonic quality, in order to optimise the success rate. Young patients with at least two top-quality embryos available, a high uterine score and a low pulsatility index, have a high risk of multiple births and are suitable for a single-embryo transfer.

Adult↗
PubMed1993

Cost effects of surfactant therapy for neonatal respiratory distress syndrome.

OBJECTIVE: To examine the cost effects of a single dose (5 ml/kg) of a protein-free synthetic surfactant (Exosurf) as therapy for neonatal respiratory distress syndrome, for both rescue and prophylactic therapy. RESEARCH DESIGN: Nonblinded, randomized clinical trials of both rescue and prophylactic therapy. Regression analyses were used to control for the independent effects of sex, multiple birth, delivery method, birth weight, and surfactant therapy. SETTING: The prophylactic trial was conducted at a university medical center only; the rescue trial also included a tertiary community hospital. PATIENTS: Prophylaxis was administered immediately after birth to 36 infants (38 control subjects) with birth weights between 700 and 1350 gm. Rescue therapy was administered at 4 to 24 hours of age to 53 infants (51 control subjects) with established respiratory distress syndrome and birth weights > or = 650 gm (no upper limit). Infants in the prophylactic trial were not eligible for the rescue trial. RESULTS: For the rescue trial, there was a $16,600 reduction in average hospital costs (p = 0.18), which was larger than the cost of the surfactant ($450 to $900), yielding a probable net savings. For the prophylactic trial, hospital costs were larger for treated infants versus control subjects who weighed less than about 1100 gm at birth and lower for treated infants versus control subjects who weighed more than 1100 gm at birth (p < 0.05). For the prophylactic sample, the result was an average cost per life saved of $71,500. CONCLUSIONS: Single-dose rescue surfactant therapy is probably a cost-effective therapy because it produced a lower mortality rate for the same (and probably lower) expenditure. Single-dose prophylactic therapy for smaller infants (< or = 1350 gm) appeared to yield a reduction in mortality rate for a small additional cost. The use of multiple-dose therapy in infants who do not respond to initial therapy may alter the effects described above to either increase or decrease the observed cost-effectiveness of surfactant therapy. Regardless, surfactant therapy will remain a cost-effective method of reducing mortality rates, relative to other commonly used health care interventions.

Costs and Cost Analysis↗
PubMed1994

Ethnic differences in the incidence of the sudden infant death syndrome (SIDS) in Victoria, Australia 1985-1989.

In order to describe ethnic differences in the incidence of the sudden infant death syndrome (SIDS) records of all livebirths in the State of Victoria, Australia, 1985-1989, excluding those who died in the first month of life, were linked to death certificates. Cases were defined as infants dying with a diagnosis of SIDS between 1 month and 1 year of age (n = 601) from the cohort of 308,052 neonatal survivors. Ethnicity was defined by the mother's country of birth. The SIDS incidence was 2.04/1000 in infants of Australian-born mothers. The relative risk of SIDS was 0.28 (95% confidence interval (CI) 0.15, 0.55) in infants whose mothers had been born in Southern Europe and 0.48 (95% CI 0.29, 0.78) in infants whose mothers had been born in Asia. SIDS in infants of Australian-born mothers was associated with low maternal age, high parity, marital status other than married, male sex, multiple birth, low birthweight and preterm birth. After adjustment for those factors in a case-control analysis using a logistic regression model the adjusted odds ratio for SIDS was 0.34 (95% CI 0.17, 0.69) comparing infants whose mothers were born in Southern Europe with infants of Australian-born mothers, and 0.60 (95% CI 0.35, 1.04) for infants whose mothers were born in Asia, compared with infants of the Australian-born. Thus there are substantial ethnic differences in SIDS which are not explained by the classic social and perinatal risk factors.

Adult↗
PubMed1993

[1992 results of sperm donor procreation. French Federation of CECOS and private cooperative centers].

In 1992, the results record the referred activity of French Federation of CECOS and IFREARES-Toulouse. 6,714 patients underwent donor inseminations for one or more cycles, 20,525 cycles were undertaken resulting in 2,234 pregnancies using AID or IVF. 606 volunteers men come forwards as donors. The analysis of 1,777 deliveries resulting of recoveries realised in 1991, showed with IVF a high rate for twins and multiple births. The activity of semen preservation and embryo's storage is always increasing. The wishes about the parentless outcome embryos is performed.

Clinical Protocols↗
PubMed1999

A small foveal avascular zone may be an historic mark of prematurity.

OBJECTIVE: To compare in children the area and diameter of the foveal avascular zone (FAZ) of former preterm infants, when no significant retinopathy of prematurity (ROP) developed, to the area and diameter of the FAZ of former term infants. DESIGN: Retrospective observational case series and literature review. PARTICIPANTS: Forty-nine children (39 former preterm infants and 10 former term infants) between the ages of 1 and 17 years had fluorescein angiograms. All of these children had been appropriate weight for gestational age at birth and had no genetic disorders. Neither eye of any of these children had any macular ectopia or vessel traction, had been treated for active ROP, had developed active ROP >stage 3 mild, or had any refractive error > +/- five diopters. Every child had a visual acuity of 20/40 or better in both eyes. METHODS: The area and greatest diameter of the FAZ were measured using digital image analysis of masked fundus fluorescein angiograms. Variables of gender, race, multiple birth, gestational age, birth weight, ROP stage, age, and refraction at the time of fluorescein angiography, and final visual acuity were recorded. RESULTS: Increasing FAZ area and greatest diameter correlated significantly with increasing gestational age and birth weight: FAZ area (microm2) versus gestational age (weeks) (R/F/P = 0.88/166.70/<0.0001); FAZ greatest diameter (microm) versus gestational age (weeks) (R/F/P = 0.87/151.10/<0.0001); FAZ area (micro/m2) versus birth weight (g) (R/F/P = 0.88/167.06/<0.0001); and FAZ greatest diameter (microm) versus birth weight (g) (R/F/P = 0.87/148.74/ <0.0001). A small or absent FAZ was found in all former preterm infants who had been < or = 30 weeks gestational age or had weighed < or = 1100 g at birth. A normal FAZ was present in all children who had been > or = 36 weeks gestational age or had weighed > or = 2650 g at birth. None of the other parameters studied correlated with FAZ area or greatest diameter. CONCLUSION: This study provides evidence that the FAZ in developing humans is initially densely vascularized with a fine meshwork of inner retinal vessels during vasculogenesis. This vascular meshwork undergoes regression by apoptosis in all infants > or = 36 weeks gestational age at birth to form a normal FAZ, but apoptosis almost never occurs in preterm infants < or = 30 weeks gestational age at birth. Although there is no effect on final visual acuity, a small or absent FAZ may be an historic mark of prematurity.

Adolescent↗
PubMedDate not supplied

[The relationship between place of birth and certain health characteristics in Ontario].

The relationship between place of birth and some health characteristics of the population of Ontario was investigated using data from the 1990 Ontario Health Survey. Adult respondents were categorized according to their region, sub-region, and country of birth. Multiple logistic and linear regression analyses indicated that immigrants were less frequently obese than were Canadian-born respondents (odds ratio [OR] = 0.75, confidence interval [CI] 0.63, 0.90), and Asians particularly so (OR = 0.56, CI 0.34, 0.91). Asians also more often had a low body mass index (OR = 3.40, CI 2.11, 5.50). Immigrants less frequently reported a health problem (OR = 0.74, CI 0.62, 0.88) than did respondents born in Canada, but they perceived their health less positively. Place of birth influences some health characteristics of the Ontario population. The differences observed need to be investigated further to develop health services adapted to the needs of the multi-cultural population of Ontario.

Adult↗
PubMed1992

Reversing the natural decline in human fertility. An extended clinical trial of oocyte donation to women of advanced reproductive age.

OBJECTIVE: To evaluate the effect of age on pregnancy success rates in functionally agonadal women undergoing oocyte donation. DESIGN: A prospective study of 100 consecutive patients using oocyte donation for the treatment of infertility. PATIENTS: Women aged 40 years and above requesting oocyte donation (N = 104) were required to undergo medical, reproductive, and psychological screening. Suitable candidates (n = 65) were matched with an oocyte donor whose cycle was synchronized with that of the potential recipient, prior to the donor's undertaking ovarian hyperstimulation and transvaginal ultrasound-directed follicle aspiration. Outcomes were compared with those of two groups undergoing therapy at the same time: (1) women below 40 years of age undergoing oocyte donation for premature ovarian failure (n = 35) and (2) women 40 years of age and above undergoing standard in vitro fertilization and embryo transfer using their own oocytes (n = 57). MAIN OUTCOME MEASURES: Embryo implantation and pregnancy rates. SETTING: The in vitro fertilization program of the University of Southern California and the California Medical Center, Los Angeles. RESULTS: Improved outcomes were observed with regard to fertilization rates in vitro, number of embryos transferred, embryo implantation rate, clinical pregnancy rates, and ongoing or successfully completed pregnancy rates when women undergoing oocyte donation regardless of age were compared with women 40 years of age and above using their own oocytes. No age-related decline in fertility was demonstrable when oocyte donation was used, with a mean age of 44.3 +/- 3.1 years for those successfully conceiving (range, 40 to 52 years). Perinatal outcomes (n = 27) were generally uncomplicated, with a mean gestational age at delivery of 38.4 +/- 2.1 weeks (range, 34 to 42 weeks), although multiple births occurred in 24.1% of cases. CONCLUSIONS: The age-related decline in female fertility may be reversed in couples electing to use donated oocytes from a younger woman, and women of advanced reproductive age may conceive, carry, and give birth to infants with success rates similar to those of their younger counterparts using assisted reproductive methods.

Adult↗
PubMed1994

Work in operating rooms and pregnancy outcome among nurses.

The aim of this study was to analyse the relationship between work in an operating room and pregnancy outcome, as described by the rates of spontaneous abortion and of birth defects. The population comprised the female nurses of 17 hospitals in Paris, interviewed in 1987-1989. An exposed group included all operating room nurses, and a control group was composed of female nurses in other departments matched by hospital, age and duration of service. Each woman described all prior pregnancies. In total, 776 pregnancies were described by 418 nurses who were first pregnant in 1970 or thereafter; ectopic pregnancies, those terminated by voluntary induced abortion and those leading to multiple births were excluded. The rate of spontaneous abortion was significantly higher for pregnancies during which women worked in an operating room than for the other pregnancies. Birth defects were not significantly related to work in an operating room during pregnancy. These results are in agreement with others showing a significant relationship between occupational exposure to operating rooms and spontaneous abortion, although identification of the responsible factor remains difficult. They suggest that effective ventilating systems should be installed in all operating rooms and that special preventive measures must be taken for women of childbearing age.

Abortion, Spontaneous↗
PubMedDate not supplied

Monozygotic twinning and IVF/ICSI treatment: a report of 11 cases and review of literature.

Monozygotic twinning is a relatively rare event in in-vivo conception, being estimated to occur in 0.42% of all births. The underlying mechanism for monozygotic twin formation is the division of the embryo early in its development. Separation of cells may theoretically occur before or after inner cell mass formation. In this analysis we report 11 cases of monozygotic twins resulting from IVF or intracytoplasmic sperm injection (ICSI) treatment cycles performed between 1991 and 1998 at St James's University Hospital, Leeds, and Bourn Hall Clinic, Cambridge, UK. Six cases (55%) followed treatment with ICSI and seven cases (64%) were in women aged > or = 35 years. This article also reviews the scientific literature discussing information pertaining to frequency, aetiology and potential complications of the monozygotic twinning phenomenon. We conclude that patients at risk of monozygotic twinning are those aged >35 years of age and those who had artificial opening in the zona pellucida by application of micromanipulation techniques. Women undergoing assisted conception treatment, particularly those with these two risk factors, must be informed of the low but definite risk of monozygotic twinning when counselled regarding the number of embryos to be transferred and chances of multiple births.

Adult↗
PubMed1998

Gestational-age-specific stillbirth risk among Australian Aborigines.

BACKGROUND: Previous studies have found that, for preterm babies, the risk of stillbirth among Australian Aborigines is similar to the risk for whites. In contrast, at full term, the risk for Aborigines is more than twice the risk for whites. However, these studies (like most other analyses of stillbirths) used the number of births at each gestational age to calculate the risk. For stillbirths, the risk is more appropriately estimated using the number of babies in utero. This paper presents the first comparison of stillbirth risk for Australian Aborigines and whites using the more appropriate denominator. METHODS: I used 6 years of data (1987-1992) from the routinely-maintained Queensland Perinatal Data Collection. Contingency-table analyses were used to compare the gestational-age-specific risk of stillbirth in Aborigines and whites. Multiple births were excluded; male and female babies were analysed separately. RESULTS: When the number of babies in utero was used as the denominator, preterm Aborigines had a statistically significant three- to fourfold increase in the risk of stillbirth compared with whites. At full term, the risks for Aborigines and whites were not statistically significantly different. CONCLUSIONS: A different pattern of gestational-age-specific stillbirth risk was obtained when the appropriate denominator was used. Specifically, the high risk of stillbirth for preterm Aborigines was revealed. Research is needed to identify the causes of the Aboriginal-white difference in stillbirth risk for preterm babies.

Australia↗
PubMed2006

Early low cardiac output is associated with compromised electroencephalographic activity in very preterm infants.

Low cerebral blood flow in preterm infants has been associated with discontinuous electroencephalography (EEG) activity that in turn has been associated with poor long-term prognosis. We examined the relationships between echocardiographic measurements of blood flow, blood pressure (BP), and quantitative EEG data as surrogate markers of cerebral perfusion and function with 112 sets of paired data obtained over the first 48 h after birth in 40 preterm infants (24-30 wk of gestation, 510-1900 g at delivery). Echocardiographic measurements of right ventricular output (RVO) and superior vena caval (SVC) flow were performed serially. BP recordings were obtained from invasive monitoring or oscillometry. Modified cotside EEGs were analyzed for quantitative amplitude and continuity measurements. RVO 12 h after birth was related to both EEG amplitude at 12 and 24 h and continuity at 24 h. Mean systemic arterial pressure (MAP) at 12 and 24 h was related to continuity at 12 and 24 h after birth. Multiple regression analyses revealed that RVO at 12 h was related to median EEG amplitude at 24 h and diastolic BP at 24 h was related to simultaneous EEG continuity. In addition, at 12 h, infants in the lowest quartile for RVO measurements (<282 mL/kg/min) had lower EEG amplitude and those in the lowest quartile for MAP measurements (<31 mm Hg) had lower EEG continuity. These results suggest a relationship between indirect measurements of cerebral perfusion and cerebral function soon after birth in preterm infants.

Animals↗
PubMed1985

A case of acardiac anomaly in the cynomolgus monkey (Macaca fascicularis): a complication of monozygotic monochorial twinning.

A case of acardius acephalus in a Macaca fascicularis is reported. This congenital anomaly occurs only in multiple-birth gestations (most commonly monozygotic twins). Artery-to-artery and vein-to-vein anastomoses appear to be a constant feature. This condition is very rare in man and probably even more so in monkeys. Classification and theories on etiology are discussed.

Abnormalities, Multiple↗
PubMed2004

Missing paternal demographics: A novel indicator for identifying high risk population of adverse pregnancy outcomes.

BACKGROUND: One of every 6 United Status birth certificates contains no information on fathers. There might be important differences in the pregnancy outcomes between mothers with versus those without partner information. The object of this study was to assess whether and to what extent outcomes in pregnant women who did not have partner information differ from those who had. METHODS: We carried out a population-based retrospective cohort study based on the registry data in the United States for the period of 1995-1997, which was a matched multiple birth file (only twins were included in the current analysis). We divided the study subjects into three groups according to the availability of partner information: available, partly missing, and totally missing. We compared the distribution of maternal characteristics, maternal morbidity, labor and delivery complications, obstetric interventions, preterm birth, fetal growth restriction, low birth weight, congenital anomalies, fetal death, neonatal death, post-neonatal death, and neonatal morbidity among three study groups. RESULTS: There were 304466 twins included in our study. Mothers whose partner's information was partly missing and (especially) totally missing tended to be younger, of black race, unmarried, with less education, smoking cigarette during pregnancy, and with inadequate prenatal care. The rates of preterm birth, fetal growth restriction, low birth weight, Apgar score <7, fetal mortality, neonatal mortality, and post-neonatal mortality were significantly increased in mothers whose partner's information was partly or (especially) totally missing. CONCLUSIONS: Mothers whose partner's information was partly and (especially) totally missing are at higher risk of adverse pregnant outcomes, and clinicians and public health workers should be alerted to this important social factor.

Journal Article↗
PubMed1998

[Genetic monitoring of the population of the Carpathian region under anthropogenic pollution of the environment].

A genetic monitoring was conducted in a number of ecological regions of Precarpathia on the basis of clinical and epidemiological indices for the frequency of spontaneous abortions, specific weight of multiple birth, dynamics of number born living over the twelve-year period of 1985-1996, with the incidence and nosological spectrum of congenital malformations and hereditary diseases having been characterized. Negative genetic changes were disclosed in those communities under health-hazard conditions. Predominance of spontaneous abortions early in gestation was established together with decline in birth rate, increase in perinatal mortality, congenital malformations, and hereditary diseases in neonates and in children having died in the perinatal period.

Abortion, Spontaneous↗
PubMed2006

Rate of referral of breech infants for hip ultrasound: an audit cycle.

BACKGROUND: Infants with risk factors for developmental dysplasia of the hip (DDH) should have hip ultrasounds performed shortly after birth to detect and treat the condition at an early stage. Breech presentation is associated with increased risk of DDH. We embarked on an audit cycle to assess and improve our rate of referral of breech infants for hip ultrasound. METHODS: Two retrospective audits (phases I and II) were carried out before, and after, the introduction of a new pro-forma which encouraged recognition of breech presentation at the time of the routine neonatal examination. Breech infants were identified from labour ward records. Multiple births and infants < 35 weeks gestation were excluded. Infants were considered to have been referred for ultrasound if the computer system at our affiliated children's hospital held a record of an ultrasound appointment. RESULTS AND CONCLUSIONS: In phase I 56% of breech infants born in our hospital had been referred for hip ultrasound. In phase II the referral rate had risen to 76% (p = 0.034). We conclude that the change in practice was effective. Further improvement might be achieved by increasing staff awareness of risk factors for DDH and by enlisting the help of advanced neonatal nurse practitioners (ANNPs) in routine neonatal examinations.

Breech Presentation↗
PubMed2002

Pulmonary embolism and stroke in relation to pregnancy: how can high-risk women be identified?

OBJECTIVE: Risks of circulatory diseases are increased substantially during late pregnancy and around the time of delivery. This study was undertaken to determine whether preeclampsia, multiple pregnancy, or cesarean delivery account for the majority of pregnancy-related risks of pulmonary embolism and stroke (caused by hemorrhage, infarction, and intracranial venous thrombosis). STUDY DESIGN: We analyzed a population-based cohort of 1,003,489 deliveries in Sweden. Relative risks of pulmonary embolism and stroke were modeled by use of Poisson regression. RESULTS: Preeclampsia was associated with 3- to 12-fold increases in risks of pulmonary embolism and stroke during late pregnancy, at delivery, and in the puerperium, and similar increases in risks were also observed for multiple pregnancies and cesarean delivery. These strong associations could not explain the overall pregnancy-related risks of pulmonary embolism and stroke. CONCLUSION: Preeclampsia, multiple birth, and cesarean delivery are important risk factors for pulmonary embolism and stroke, but they do not account for the majority of the excess risks associated with pregnancy.

Adult↗