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PubMed2005

Fetal reduction.

Fetal Reduction has been employed over the past two decades as a mechanism to reduce the morbidity and mortality of multiple pregnancies. Utilization of the procedure has increased dramatically as IVF has become commonplace but the average starting number has decreased with the transfer of fewer embryos. Success rates from fetal reduction have improved as a function of increasing experience, better ultrasound, and lower starting numbers. Genetic diagnosis prior to reduction can improve the overall outcomes. Reduction of triplets or more clearly improves outcomes, and reduction of twins to a singleton is now a reasonable consideration.

Female↗
PubMed2005

Actuarial survival of a large Canadian cohort of preterm infants.

BACKGROUND: The increased survival of preterm and very low birth weight infants in recent years has been well documented but continued surveillance is required in order to monitor the effects of new therapeutic interventions. Gestation and birth weight specific survival rates most accurately reflect the outcome of perinatal care. Our aims were to determine survival to discharge for a large Canadian cohort of preterm infants admitted to the neonatal intensive care unit (NICU), and to examine the effect of gender on survival and the effect of increasing postnatal age on predicted survival. METHODS: Outcomes for all 19,507 infants admitted to 17 NICUs throughout Canada between January 1996 and October 1997 were collected prospectively. Babies with congenital anomalies were excluded from the study population. Gestation and birth weight specific survival for all infants with birth weight < 1,500 g (n = 3419) or gestation < or = 30 weeks (n = 3119) were recorded. Actuarial survival curves were constructed to show changes in expected survival with increasing postnatal age. RESULTS: Survival to discharge at 24 weeks gestation was 54%, compared to 82% at 26 weeks and 95% at 30 weeks. In infants with birth weights 600-699, survival to discharge was 62%, compared to 79% at 700-799 g and 96% at 1,000-1,099 g. In infants born at 24 weeks gestational age, survival was higher in females but there were no significant gender differences above 24 weeks gestation. Actuarial analysis showed that risk of death was highest in the first 5 days. For infants born at 24 weeks gestation, estimated survival probability to 48 hours, 7 days and 4 weeks were 88 (CI 84, 92)%, 70 (CI 64, 76)% and 60 (CI 53, 66)% respectively. For smaller birth weights, female survival probabilities were higher than males for the first 40 days of life. CONCLUSION: Actuarial analysis provides useful information when counseling parents and highlights the importance of frequently revising the prediction for long term survival particularly after the first few days of life.

Actuarial Analysis↗
PubMed2003

Sextuplets in Oman.

Use of ovulation inducing agents has increased the incidence of high order multifetal gestation. Such pregnancies are associated with increased maternal morbidity and poor perinatal outcome especially due to prematurity. Here, we report a case of sextuplet pregnancy following ovulation induction with gonadotrophins. This is the first reported case of sextuplets from Oman.

Adult↗
PubMed1988

Demographic parameters and twinning: a study in Catalonia, Spain.

Twinning rates for the years 1975-79 in Catalonia (Spain) are presented. Crude rates are very low: 7.62 per 1,000 maternities, the DZTR and the MZTR being 3.74 and 3.88 respectively. Standardized rates remain very low. Sex ratio among twin couples is also very low (0.49 male vs 0.51 female births). A multiple linear stepwise regression on the twinning rates shows MZ rates to be influenced by birth order and father's age, and the DZ rates by mother's age and birth order.

Adult↗
PubMed1976

Esophageal atresia and associated anomalies.

One hundred and two patients with esophageal atresia possessed 237 additional anomalies. Risk grouping of these patients was useful and showed a direct relationship between the increased incidence of anomalies, low birth weight, and nonsurvival. Fifty-seven per cent of the patients with additional anomalies possessed multiple anomalies, most frequently occurring in the gastrointestinal, cardiovascular, and musculosketetal organ systems. Fifty-five per cent of the deaths appeared to result from the coexistent severe anomaly, while the remaining 45% of the deaths appeared to occur as a result of the presence of esophageal atresia. It is our suspicion that the insult producing esophageal atresia with a high incidence of associated anomalies occurs at a more critical time in organogenesis than that event that produces the esophageal atresis alone or with one moderate anomaly.

Abnormalities, Multiple↗
PubMedDate not supplied

Perinatal mortality and morbidity in rural West-Java, Indonesia. Part II: The results of a longitudinal survey on pregnant women.

The main objective of this prospective survey is to obtain more information on the natural history of pregnancy and its outcome, including low birth weights, and of the factors closely associated with it. During the survey period the birth rate was 40 per thousand and the perinatal death rate 48 per thousand. The main causes of neonatal deaths are infections (predominantly tetanus) and hypoxia/birth asphyxia. Perinatal mortality is significantly associated with the following risk factors: age of mother less than 20 years; birth interval shorter than 18 months, twins, and breech presentation. The incidence of low birth weight is 14.7%. Statistically significant associations have been found between low birth weight and several risk factors.

Birth Weight↗
PubMed1992

First-year mortality among infants with facial clefts.

Children born with a facial cleft are not thought to be at a greater risk for infant mortality than are those without congenital anomalies. The purpose of this study was to investigate whether the presence of a facial cleft alone or its coexistence with other anomalies increases a child's risk for dying. Birth and death certificate data from Washington State for the years 1984 to 1988 were linked for infants who died before 1 year of age. Mortality rates for different types of facial clefts and for births without noted abnormalities were compared. Relative to infants with no diagnosed abnormalities noted in the birth certificate, infants with facial clefts without other abnormalities have a 3.7 fold increased odds for dying during their first year of life. This elevated risk for dying was fairly consistent during the first year of life. When facial clefts are associated with other abnormalities there is an 82.3 fold increase in odds for mortality during the first year of life. This elevated risk is highest during the neonatal period; 77% of all deaths occurred during the first 27 days. It is concluded that infants with facial clefts with or without associated anomalies have a significantly increased mortality risk when compared to infants without any diagnosed abnormalities at birth.

Abnormalities, Multiple↗
PubMed2005

Addressing the growing problem of multiple gestations created by assisted reproductive therapies.

Iatrogenic multiple pregnancy is the most significant complication of assisted reproductive technology (ART). Approximately half of all children born subsequent to ART result from a plural gestation. Furthermore, the majority of triplets and higher order births are the product of ART. The risks for multiple pregnancy vary with practice patterns and the techniques used to achieve pregnancy. Recognizing the potential for serious morbidity associated with multiple pregnancies, infertility specialists have developed strategies to reduce the complication of multiple pregnancies while maintaining acceptable pregnancy rates. Implementation of these refined practices has led to a reduction in the incidence of higher order multiple births, although the incidence of twins has yet to be minimized. Further reduction in the incidence of multiple births after ART necessitates a redefinition of success to emphasize the healthy singleton birth rate, rather than crude pregnancy rates.

Female↗
PubMed1998

Lowering the cesarean section rate in a private hospital: comparison of individual physicians' rates, risk factors, and outcomes.

OBJECTIVE: Our purpose was to compare the practice patterns and outcomes of physicians delivering in our institution to identify risk factors and management techniques that could explain the differences in individual cesarean section rates. STUDY DESIGN: We retrospectively reviewed detailed computerized delivery records (n = 16,230) collected from May 16, 1988, to July 30, 1995. We excluded physicians who had <100 deliveries at our institution during the study period. The physicians were divided into two groups depending on whether their individual cesarean section rates were greater than (control group) or less than 15% (target group). Various cesarean section rates, risk factors for abdominal delivery, labor management techniques, and neonatal outcome parameters were calculated for each group. The cesarean section rates of the two groups were analyzed by year to assess changes. RESULTS: As expected by study design, the overall cesarean section rate was markedly different between the two groups (13.8% vs 23.8%). In addition, the primary, repeat, primigravid, and multiparous cesarean section rates were all lower for the target group. The rates of cesarean section for fetal distress (1.5% vs 3.3%) and cephalopelvic disproportion (5.3% vs 8.5%) were also significantly less in the target group. The rates of breech presentation, third-trimester bleeding, and active herpes cesarean sections were not lower. The control group had more postterm (8.6% vs 14.7%) and >4000 gm infants (12.0% vs 13.7%) but similar numbers of low birth weight, multiple gestation, and preterm infants. The target group used more epidural anesthesia, oxytocin induction, and trial vaginal births after cesarean delivery and more successful trial vaginal births after cesarean sections. Over the study period the cesarean section rate in the target group remained unchanged, whereas it steadily declined in the control group. CONCLUSIONS: Individual physician's lower cesarean sections are primarily obtained by labor management and attempting vaginal birth after cesarean delivery. These practice patterns did not appear to lead to any increase in perinatal morbidity or mortality. Efforts to lower cesarean section rates of individual practitioners should focus on the areas of fetal distress, cephalopelvic disproportion, and repeat cesarean section.

Adolescent↗
PubMed2006

Customised birthweight: coefficients for an Australian population and validation of the model.

BACKGROUND: Published birthweight references in Australia do not fully take into account constitutional factors that influence birthweight and therefore may not provide an accurate reference to identify the infant with abnormal growth. Furthermore, studies in other regions that have derived adjusted (customised) birthweight references have applied untested assumptions in the statistical modelling. AIMS: To validate the customised birthweight model and to produce a reference set of coefficients for estimating a customised birthweight that may be useful for maternity care in Australia and for future research. METHODS: De-identified data were extracted from the clinical database for all births at the Mater Mother's Hospital, Brisbane, Australia, between January 1997 and June 2005. Births with missing data for the variables under study were excluded. In addition the following were excluded: multiple pregnancies, births less than 37 completed week's gestation, stillbirths, and major congenital abnormalities. Multivariate analysis was undertaken. A double cross-validation procedure was used to validate the model. RESULTS: The study of 42,206 births demonstrated that, for statistical purposes, birthweight is normally distributed. Coefficients for the derivation of customised birthweight in an Australian population were developed and the statistical model is demonstrably robust. CONCLUSIONS: This study provides empirical data as to the robustness of the model to determine customised birthweight. Further research is required to define where normal physiology ends and pathology begins, and which segments of the population should be included in the construction of a customised birthweight standard.

Australia↗
PubMedDate not supplied

Is fetal growth affected by cord entanglement?

Cord entanglement is a common occurrence during delivery. We examined the association of cord complications observed at delivery and birth weight. A retrospective survey of 12,241 births was performed, supplemented with a prospective study of an additional 456 deliveries. No adverse association was found in the retrospective data between cord coiled twice or more around the newborns' neck (8.3% of cases) and birth weight. Moreover, the incidence of cord around neck was significantly lower (p < 0.0006) in infants weighing less than 2000 gm at birth. A multiple regression analysis of the prospective data did not reveal any significant influence of cord complications on birth weight. We conclude that cord entanglement was not found to be a major cause of intrauterine disadvantage in pregnancies with a viable infant at term, as reflected by birth weight.

Adult↗
PubMed2004

Assisted reproductive technology : experience with IVF/ICSI.

OBJECTIVE: To analyze success rates of assisted reproduction techniques ART (IVF/ICSI) in couples experiencing subfertility, and factors which may help in predicting treatment outcome. DESIGN: A prospective cohort follow-up study. PLACE AND DURATION OF STUDY: Study was conducted at Concept Fertility Centre, Karachi, between July 1, 2000 and December 31, 2002. SUBJECTS AND METHODS: A cohort of 310 couples undergoing 330 in-vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI) cycles were followed for treatment outcomes. Predictor variables included age of women, cause of subfertility, drug regimen used for ovulation induction, day of embryo transfer, and ease of embryo transfer. While outcome variables included rates of fertilization, pregnancy, live birth, miscarriages, multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). RESULTS: The overall pregnancy rate was 35.2 %, while takehome live-birth rate was 25.1%. Treatment cycles which were done for male factor only, had higher probability of success as compared to female factors or for unexplained infertility. Patients who underwent transvaginal ovum pick up and embryo transfer (TVOPU + ET) had an overall pregnancy rate of 29.4% as compared to those who underwent frozen embryo transfer (FET) cycles (22.6%). There was no statistically significant difference between pregnancy rates for ovulation induction with recumbent FSH (rFSH) and HMG (32.7% v 33.6%, p-value 0.87). Quality of embryo transfer was significantly better (33.7%, v 24.2%, p-value 0.042) in patients who conceived. CONCLUSION: Our results are comparable in terms of pregnancy rates, live birth rates and complication rates, to the results reported in international literature. We however, need more data from centres in Pakistan for future reference and research.

Adult↗