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PubMed2006

Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery.

OBJECTIVE: To determine whether the risk for uterine rupture is increased in women attempting vaginal birth after multiple cesarean deliveries. METHODS: We conducted a prospective multicenter observational study of women with prior cesarean delivery undergoing trial of labor and elective repeat operation. Maternal and perinatal outcomes were compared among women attempting vaginal birth after multiple cesarean deliveries and those with a single prior cesarean delivery. We also compared outcomes for women with multiple prior cesarean deliveries undergoing trial of labor with those electing repeat cesarean delivery. RESULTS: Uterine rupture occurred in 9 of 975 (0.9%) women with multiple prior cesarean compared with 115 of 16,915 (0.7%) women with a single prior operation (P = .37). Multivariable analysis confirmed that multiple prior cesarean delivery was not associated with an increased risk for uterine rupture. The rates of hysterectomy (0.6% versus 0.2%, P = .023) and transfusion (3.2% versus 1.6%, P < .001) were increased in women with multiple prior cesarean deliveries compared with women with a single prior cesarean delivery attempting trial of labor. Similarly, a composite of maternal morbidity was increased in women with multiple prior cesarean deliveries undergoing trial of labor compared with those having elective repeat cesarean delivery (odds ratio 1.41, 95% confidence interval 1.02-1.93). CONCLUSION: A history of multiple cesarean deliveries is not associated with an increased rate of uterine rupture in women attempting vaginal birth compared with those with a single prior operation. Maternal morbidity is increased with trial of labor after multiple cesarean deliveries, compared with elective repeat cesarean delivery, but the absolute risk for complications is small. Vaginal birth after multiple cesarean deliveries should remain an option for eligible women. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2002

Higher order multiple pregnancies in New South Wales 1990-1999.

OBJECTIVE: To examine higher order multiple pregnancy and birth rates in NSW, and to describe trends in the characteristics and management of these births. DESIGN: Cross-sectional analytic study. SETTING: New South Wales, Australia. POPULATION: Two hundred and ninety-one women who gave birth to triplets, quadruplets or quintuplets (880 babies) from 1 January 1990 to 31 December 1999. METHODS: Data were obtained from the NSW Midwives Data Collection and rates over time were calculated. MAIN OUTCOME MEASURES: Higher order multiple birth and pregnancy rates (> or = 20 weeks), place of birth, mode of delivery, fetal death rates and Apgar scores. RESULTS: There was no significant change in the number or rate of higher order multiple births in NSW during the 1990s with an average annual rate of 10.3/10,000 births or 3.5/10,000 pregnancies > or = 20 weeks. Among women with higher order multiple pregnancies, those aged > or = 35 years increased from 19% in 1990 to 47% in 1999. There was also a trend towards delivery in a perinatal centre from 56% to 70%, and vaginal birth from 18% to 28%. There were no significant changes in infant outcomes. CONCLUSIONS: The increases in higher order multiple pregnancies observed in Australia in the 1980s, and into the 1990s in other countries, have not persisted in NSW, suggesting that guidelines for limiting the number of embryos/oocytes transferred in assisted reproductive technologies have been widely adopted.

Adult↗
PubMed1990

Births in Great Britain resulting from assisted conception, 1978-87. MRC Working Party on Children Conceived by In Vitro Fertilisation.

OBJECTIVE: To describe the characteristics at birth of children conceived by in vitro fertilisation (IVF) or by gamete intrafallopian transfer (GIFT) and to assess whether they differ from those of children conceived naturally. DESIGN: Survey of children resulting from IVF or GIFT and comparison of their characteristics at birth with national statistics. SETTING: England, Scotland, and Wales from 1978 to 1987. SUBJECTS: 1267 Pregnancies conceived by IVF or GIFT, which resulted in 1581 liveborn or stillborn children. MAIN OUTCOME MEASURES: Sex ratio, multiplicity, gestational age at birth, birth weight, stillbirth rate, perinatal and infant mortality, and prevalence of congenital malformations. RESULTS: The ratio of male to female births was 1.07:1; 23% (249/1092) of the deliveries were multiple births compared with 1% for natural conceptions; 24% (278) of 1015 deliveries were preterm compared with 6% in England and Wales; 32% (406) of 1269 babies weighed less than 2500 g compared with 7% in England and Wales. The high percentage of preterm deliveries and of low birthweight babies was largely, but not entirely, due to the high frequency of multiple births. The rate of stillbirth, perinatal mortality, and infant mortality were twice the national average, these excesses being due to the high frequency of multiple births. One or more major congenital malformations were detected during the first week of life in 35 (2.2%) of 1581 babies. This figure is comparable with population based estimates of the prevalence of congenital malformations. The types of malformations reported varied, and the number of each specific type was small. The health of the children was not evaluated beyond the perinatal period. CONCLUSIONS: Multiple pregnancies often result from assisted conception and are the main determinant of the outcome of the pregnancies and of the health of the children at the time of birth. Congenital malformations are comparatively rare, so larger numbers of children need to be studied before firm conclusions can be drawn. The pooling of data from different countries is recommended.

Birth Weight↗
PubMed2004

An epidemiologic study of isolated cleft lip, palate, or both in Victoria, Australia from 1983 to 2000.

OBJECTIVES: To report the epidemiological characteristics of isolated cleft lip, cleft palate or both (CL +/- P and CP) using population-based data in Victoria, Australia. DESIGN: Descriptive study of a cohort of children born between 1983 and 2000 notified to the Victorian Birth Defects Register by multiple ascertainment sources. PARTICIPANTS: Data were collected on patients identified with CL +/- P and CP without associated defects classified as live births, stillbirths, neonatal deaths, and terminated pregnancies < 20 weeks' gestation following prenatal identification. Information was collected on sex, plurality, maternal age, and country of birth. RESULTS: The overall prevalence (per 10,000 pregnancies) of CL +/- P was 7.8 (95% confidence interval [CI] = 7.30, 8.33; cleft lip [CL] 3.3; 95% CI = 2.97, 3.65, CL+P 4.5; 95% CI = 4.13, 4.91) and cleft palate (CP), 4.3 (95% CI = 3.89, 4.66). The prevalence of CL + P was higher among stillbirths, neonatal deaths, and terminated pregnancies than CL (without CP) and CP. Boys were at greater risk than girls for CL +/- P and girls at greater risk than boys for CP. Regardless of cleft type, there was a nonsignificant excess of clefts among singleton births than multiple births and no related effects of maternal age or country of birth. CONCLUSIONS: The prevalence of isolated CL +/- P and CP in Victoria parallels other population-based studies of the same conditions. Inclusion of stillbirths, neonatal deaths, and terminations had little impact on rates. The effect of sex and plurality on cleft type is consistent with the literature, but the effects of maternal age and country of birth remain equivocal. Further studies focusing on certain ethnic groups are warranted to explain the higher rates observed.

Analysis of Variance↗
PubMed2000

[Analysis of prognostic factors in a group of infants from multiple pregnancy and very low birth weight].

UNLABELLED: Preterm birth remains a major cause of perinatal morbidity and mortality. The purpose of the study was to examine factors influencing on the survival and early prognosis of very low birth weight premature infants in multiple gestation born at the Department of Obstetrics and Perinatology University School of Medicine in Lublin. Congenital malformations were excluded from the study. CONCLUSION: In this retrospective analysis the reduction in the incidence of respiratory distress syndrome in multiple gestation was observed. Survival was significantly correlated to prenatal corticoid prophylaxis, Apgar score and lack of the respiratory distress syndrome. The mortality showed an inverse correlation to birth weight and age of gestation.

Adult↗
PubMedDate not supplied

Incidence of low birth weight infants born to mothers with multiple risk factors.

Low birth weight (LBW) is associated with a large number and variety of risk conditions during pregnancy. The number and types of risk conditions per pregnancy were determined in 1,864 white and 872 black mothers delivered at the University of Kansas Medical Center between 1975 and 1978. The incidence of LBW infants increased steadily among white and black mothers as the number of risk factors increased from none to three or four per pregnancy. Among pregnancies without spontaneous premature rupture of membranes (PROM), 51 percent of the LBW infants were born to mothers who had multiple risk factors associated with their pregnancies, even though only 18 percent of these pregnancies were associated with multiple risk factors. Among pregnancies with PROM, 72 percent were associated with multiple risk conditions, and 31 percent resulted in LBW infants. About 90 percent of LBW infants from PROM pregnancies had mothers with multiple risk factors. For all numbers of risk conditions, black mothers had a higher incidence of LBW infants than white mothers. Among black mothers without spontaneous premature rupture of membranes (PROM), the incidence of LBW infants increased from 3.2 percent (10/308) in low (zero)-risk condition pregnancies to 33 percent (16/49) among mothers with three or four risk conditions during the pregnancy. Among white mothers without PROM, the incidence of LBW infants increased from 1.7 percent (12/708) in low (zero)-risk condition pregnancies to 30 percent (19/64) in pregnancies with three or four risk conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Seasonal variation of livebirths, stillbirths, extramarital births and twin maternities in Switzerland.

A study was made of the seasonal variation in all births, and births according to marital status, multiplicity and birth status (live and still) in Switzerland recorded between 1876 and 1990. To obtain seasonal variation in as pure as possible form, our analyses are based on rates. When comparing the seasonality in data sets showing markedly different levels, standardised indices were used. Assuming the length of pregnancies with twins to be about one month shorter than for pregnancies with singletons, lagged twinning rates were calculated but, in comparison with actual twinning rates, the general seasonal variation remained. Therefore, this study was based on actual twinning rates. A monotonic increase in the amplitude of the seasonal variation in general births was noted for the period 1876-1930, with strong seasonal variation holding for 1921-1980. After that, a marked decline in the amplitude can be observed. Seasonality of both all births and twin maternities showed very similar pattern for the periods 1876-1930 and 1969-1990, with maxima in the spring (March-May) and troughs in late autumn (October-December). Twin maternities showed a strong seasonality for the period 1876-1930, being about 20% higher in March than in October. The twinning rate in the period 1876-1930 was about 2.6 per thousand units higher than in the period 1969-90. For twin maternities there was also a stronger seasonal variation during the earlier period than during the later one. The pattern of the seasonal variation for extramarital births, showing a maximum in February (conceptions in May-June) and a minimum in August (conceptions in November-December) with a difference of no less than 24% was more marked than for the marital births. It seems likely that this seasonality of extra-marital maternities was due mainly to seasonal variation of coital rates and multiple ovulation in the early summer months coinciding with optima of light, temperature and food supply. A strong reduction in the rate of stillbirths (gestational age more than 29 weeks) was observed during the twentieth century. The stillbirth rate declined from about 40 per 1000 in the 1870s to fewer than 5 per 1000 in the 1980s. Irrespective of this strong decline in the stillbirth rate, the same seasonal rhythm was noticed throughout the period with high stillbirth rates among births around March and low rates during the summer and autumn.

Abortion, Spontaneous↗
PubMed1990

Fetal deaths with birth defects among Japanese multiples, 1974.

Source of data is "Survey on Socio-Economic Aspects of Vital Events-Plural Births in 1975", including 12,392 twin pairs, 124 triplet sets, 7 quadruplet sets and 1 quintuplet set. Fetal deaths were 3,285 for twins, 141 for triplets, 17 for quadruplets, and 5 for quintuplets, among which the number of birth defects were 78, 3, 0, and 0 respectively. Concordant twin pairs with the same category of birth defect were 20 among 56 pairs (0.36). As for the remaining 36 pairs, 2 pairs had different category of birth defects, 27 pairs had liveborn cotwins, and 7 pairs were both fetal deaths among which a twin had birth defect. The second-born twins had birth defects more frequently than the first-born twins among fetal deaths (28 vs 6).

Congenital Abnormalities↗
PubMed1991

Multifetal pregnancy reduction: a Belgian experience.

Multifetal pregnancy reductions were performed during the first trimester of pregnancy in 26 patients. Transabdominal intrathoracic KC1 injections were performed in 23 cases, and transcervical aspirations in 3 cases. There were 4 miscarriages (15%) during the second trimester, 18 pregnancies ended in 33 births, 4 pregnancies are going on uneventfully and are beyond 32 weeks. There was no maternal morbidity related to the procedure; fetal morbidity has been mild.

Abortion, Induced↗
PubMed2000

Hyperemesis gravidarum in a contemporary population in Oslo.

BACKGROUND: Sociodemographic studies of hyperemesis gravidarum are conflicting. During the last few years, there has been a clinical impression in Norway that immigrants are more afflicted than ethnic Norwegians. METHODS: Of 175 patients hospitalized with the diagnosis hyperemesis gravidarum 1993-1997, 120 had complete records and were compared to a control group of 115 patients without hyperemesis gravidarum, drawn at random from the labor ward protocol. VARIABLES: Ethnicity, age, height, weight at the beginning and at the end of pregnancy, body mass index, gravidity, parity, smoking, gestational age at labor, birth weight, placental weight. The patient's first name was used as an indication of ethnicity. Having a non-Norwegian name means, in the majority of cases, being a first generation immigrant from a developing country. STATISTICS: SPSS statistical package for regression analyses, the chi-square test with Yates correction and the Mann-Whitney U-test. RESULTS: Risk factors for hyperemesis: non-Norwegian name (OR 3.4, 95% CI 1.5-7.6), female sex of the infant (OR 2.6, 95% CI 1.3-5.3), gravidity number (OR 1.4, 95% CI 1.1-1.9). These two last variables were of significance only in patients with a Norwegian name. The hyperemesis group had a lower weight gain and birth weight. In a stepwise multiple regression birth weight (g) was dependent on weight increase (kg) (B=19.0, p=0.001), weight in early pregnancy (kg) (B=8.0, p =0.02) and parity (B= 107.1, p=0.02). Hyperemesis, when corrected for weight increase, did not influence birth weight. CONCLUSIONS: Risk factors vary between different populations. Hyperemesis patients are at risk of having infants with reduced growth.

Adult↗
PubMed2006

Guidelines for the number of embryos to transfer following in vitro fertilization.

OBJECTIVE: To review the effect of the number of embryos transferred on the outcome of in vitro fertilization (IVF), to provide guidelines on the number of embryos to transfer in IVF-embryo transfer (ET) in order to optimize healthy live births and minimize multiple pregnancies. OPTIONS: Rates of live birth, clinical pregnancy, and multiple pregnancy or birth by number of embryos transferred are compared. OUTCOMES: Clinical pregnancy, multiple pregnancy, and live birth rates. EVIDENCE: The Cochrane Library and MEDLINE were searched for English language articles from 1990 to April 2006. Search terms included embryo transfer (ET), assisted reproduction, in vitro fertilization (IVF), ntracytoplasmic sperm injection (ICSI), multiple pregnancy, and multiple gestation. Additional references were identified through hand searches of bibliographies of identified articles. VALUES: Available evidence was reviewed by the Reproductive Endocrinology and Infertility Committee and the Maternal-Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada and the Board of the Canadian Fertility and Andrology Society, and was qualified using the Evaluation of Evidence Guidelines developed by the Canadian Task Force on the Periodic Health Exam. BENEFITS, HARMS, AND COSTS: This guideline is intended to minimize the occurrence of multifetal gestation, particularly high-order multiples (HOM), while maintaining acceptable overall pregnancy and live birth rates following IVF-ET.

Adult↗
PubMed1988

Increase in maternity leave.

As of January 1986, maternity leave in Mongolia for mothers who give birth to twins is increased to one year, as measured from the date of birth.

Asia↗
PubMed2006

Does the season or month of birth influence disease progression in multiple sclerosis?

We investigated the influence of season and birth month on sustained progression to Expanded Disability Status Scale 6 (requires a cane) through a database review of 2,319 definite multiple sclerosis (MS) patients followed for a mean 19.3 years, until July 2003 in British Columbia, Canada. The season of birth had a marginal effect on disease progression (p = 0.051), with winter babies exhibiting the slowest progression (p = 0.048). Birth month had a significant effect on progression (p = 0.038), mainly due to those January born having a 40% (95% CI 32.9-47.4) chance of requiring a cane later than those born in other months. There was some evidence to suggest that the gestational period had a small but long-lasting effect on later disease progression in British Columbia, Canada.

Adult↗
PubMed1990

Outpatient gamete intrafallopian transfer: a clinical analysis of 710 cases.

From February 1986 to June 1989 445 infertile couples were treated with a total of 710 treatment cycles involving laparoscopic gamete intrafallopian transfer (GIFT). The median age of the female partner was 33.5 years (range, 24 to 49 years) and the median duration of infertility was 4 years (range, 2 to 20 years). The final outcome of all 217 clinical pregnancies is known. There were 150 live births among which all but one baby survived, comprising 112 singleton births, 28 twin births, nine triplet births and one quadruplet birth. There were no still births, but there were two premature, multiple live births (one triplet, one quadruplet) among which no babies survived the neonatal period. Overall, 40 of the 152 potentially viable pregnancies were multiple (26.3%). Three of 206 potentially viable babies were born with congenital anomalies (1.5%). There were 50 clinical spontaneous abortions (24.8% of uterine pregnancies), one termination of pregnancy for Down's syndrome, and 14 ectopic pregnancies rate was 30.6% per laparoscopy and, among 740 initiated cycles, a live and surviving birth-per-initiated-cycle rate of 20.2%, or 33.7% to date per couple entering the programme. The 710 laparscopies resulted in two serious complications (0.3%), one of which required laparotomy. Eight other patients were admitted to hospital for rest and observation because of painful ovarian enlargement in the luteal phase. The total inpatient admission rate was 1.4%. Outpatient laparoscopic GIFT under general anaesthesia is a safe and effective procedure when conventional treatment for infertility has been unsuccessful.

Abortion, Spontaneous↗
PubMed1976

Birth defects involving the spine.

There is a multiplicity of birth defects of the spine occurring as isolated anomalies or as aspects of multifaceted syndromes. The clinical significance of these anomalies varies from the asymptomatic to the life threatening. Symptoms and signs may present at birth or not until years later. The optimal clinical result for the patient requires a careful history and physical examination, appropriate routine and specialized roentgenograms, laboratory data, and a high index of suspicion for signs or symptoms of neurological dysfunction. When the diagnosis is made, conservative or surgical treatment may be instituted as appropriate.

Atlanto-Occipital Joint↗
PubMed1980

Risk of multiple sclerosis inversely associated with birth order position.

The aim of this study was to ascertain whether there is an association between risk of multiple sclerosis (MS) and birth order position. Our reference population was 198,000 persons born in the period 1930-50 and recorded in the register of school health records from the school health service of the Copenhagen council. We compared 46 persons from the register who had developed MS with matched controls from the register, three for each case. An inverse association between risk of MS and birth order position was found. Early birth orders tend to delay exposure to an infectous agent from early childhood to a later age. Therefore, our finding supports the hypothesis that MS is causally related to an infection that is inapparent when it occurs in early childhood, while infection later in life may result in severe disease

Birth Order↗