Abstract:
BACKGROUND:As compared with singleton gestations, twin pregnancies are associated with a significantly higher risk of preterm birth and maternal complications as well as fetal and neonatal morbidity and mortality. Multifetal pregnancy reduction is a technique developed in the 1980s to reduce the fetal number in higher-order multiple pregnancies to reduce the risk of adverse pregnancy outcomes, most importantly preterm birth. OBJECTIVE:The objective of the study was to compare pregnancy outcomes and loss rates in elective twin pregnancy reduction to ongoing twin gestations in a large contemporary cohort. STUDY DESIGN:This was a retrospective review of dichorionic diamniotic twin gestations that underwent first-trimester ultrasound at our institution from January 2008 to September 2016. Planned elective 2-to-1 multifetal pregnancy reductions at less than 15 weeks' gestation were compared with ongoing dichorionic diamniotic twin gestations. Data were collected via chart review. Demographics between 2-to-1 reduced singletons and ongoing twins were assessed using a Student t test or a Wilcoxon rank-sum test, as appropriate, for continuous variables and χ2 or Fisher exact tests, as appropriate, for categorical variables. Univariable and multivariable logistic regressions were used to compare pregnancy outcomes between ongoing twins and reduced singletons adjusting for maternal age, body mass index, race, in vitro fertilization, use of chorionic villus sampling, prior term birth, and prior preterm birth. RESULTS:Of 1070 dichorionic diamniotic twin pregnancies identified, completed follow-up data were available and analyzed for 855 patients (79.9%). Among those, 250 (29.2%) were 2-to-1 singletons and 605 (70.8%) were ongoing twins. Reduced singleton patients were slightly older, more likely white, and had lower body mass index. They were also more likely to have undergone in vitro fertilization (63.6% vs 48.8%), had chorionic villus sampling (92% vs 37.5%), and had prior term births (54% vs 35.7%). Compared with 2-to-1 singletons, the adjusted odds of having preterm delivery at 37 weeks for ongoing twins were 5.62 times (95% confidence interval, 3.67-8.61; P < .001) and 2.22 times (95% confidence interval, 1.20-4.11; P < .001) at 34 weeks. While intrauterine growth restriction, placental abruption, and gestational diabetes were not significant, ongoing twins were more likely to have a cesarean delivery (odds ratio, 5.53, 95% confidence interval, 3.60-8.49; P < .001) and preeclampsia (odds ratio, 3.33, 95% confidence interval, 1.60-6.96; P < .001) after adjusting for maternal characteristics. There were also significant differences between groups for preterm premature rupture of membranes and low birthweight at less than the fifth and 10th percentiles. Total pregnancy loss (at 24 and 20 weeks) was similar between singleton and ongoing twins (4% vs 2.5%, P = .23, and 3.6% vs 1.7%, P = .09 for respective weeks). There were no significant differences in the rate of unintended pregnancy loss (2.4% vs 2.3%; P = .94) and the rate of intrauterine fetal death greater than 24 weeks (1.2% vs 0.7%; P = .43) in reduced singleton versus ongoing twin group, respectively. CONCLUSION:In our study, patients who elected to reduce to a singleton pregnancy had a higher gestational age of delivery and lower rates of preterm birth and pregnancy complications without an increased risk of pregnancy loss.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Vieira LA,Warren L,Pan S,Ferrara L,Stone JLdoi
10.1016/j.ajog.2019.04.001subject
Has Abstractpub_date
2019-09-01 00:00:00pages
253.e1-253.e8issue
3eissn
0002-9378issn
1097-6868pii
S0002-9378(19)30530-7journal_volume
221pub_type
杂志文章abstract::Sustained and vigorous fetal breathing activity was produced in a chronic fetal lamb preparation by infusion into the fetus of either NH4Cl or HCl. Over a 2 to 3 hour period, 20 to 25 mEq/kg were infused. All of the fetuses tolerated blood pH values of 6.7 to 6.8 and survived. The breathing activity began after the co...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)91012-1
更新日期:1980-03-01 00:00:00
abstract::Because serum CA-125 concentrations are increased in women with endometriosis, our objective was to determine whether CA-125 levels could be used to differentiate endometriotic from nonendometriotic benign cysts. During a 2-year period, all women who had an endometrioma (n = 33) or a nonendometriotic cyst (n = 27) tha...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80237-5
更新日期:1987-12-01 00:00:00
abstract::A randomized prospective trial was performed to compare the efficacy and safety of ritodrine and indomethacin in the long-term treatment of preterm labor. Forty patients with intact membranes in preterm labor at 23 to 34 weeks' gestation were randomized to receive either intravenous ritodrine or oral indomethacin as t...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9378(91)90569-d
更新日期:1991-04-01 00:00:00
abstract:OBJECTIVES:Endotoxin, interleukin-1 beta, interleukin-6, and tumor necrosis factor-alpha have been implicated in the pathogenesis of preterm labor, but their acute effect on myometrial contractile activity is unknown. The objective of this study was to determine their effect on isolated pregnant murine myometrial contr...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90412-c
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVE:Our purpose was to compare the effects of the Burch colposuspension with those of the modified Marshall-Marchetti-Krantz urethropexy. STUDY DESIGN:Eighty women underwent the two types of operation. A full urodynamic investigation was repeated 6 months after surgery. RESULTS:Clinical follow-up continued for ...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9378(94)90404-9
更新日期:1994-12-01 00:00:00
abstract:OBJECTIVES:Fascia lata allografts are commonly used in urogynecologic procedures. Functional failure of several grafts has occurred, and such failure has been recognized as a materials problem in 12 patients. STUDY DESIGN:Twelve patients with failure of an initial urogynecologic procedure performed with irradiated and...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70374-1
更新日期:1999-12-01 00:00:00
abstract::A comparison was made of the incidences of cesarean section deliveries between mothers 18 years of age or younger and those 19 to 21 years of age, all of whom were enrolled in a comprehensive program of prenatal care. Also compared were the indications for surgical delivery between the two groups. The rate of cesarean...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(85)80033-8
更新日期:1985-07-15 00:00:00
abstract:OBJECTIVE:The standard weekly dose of 17-alpha hydroxyprogesterone caproate (17OHP-C; 250 mg/wk) to reduce the risk of recurrent preterm birth was adopted without regard to patient characteristics. We examined the relationship between prepregnancy body mass index (BMI) and gestational age at birth after 17OHP-C prophyl...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2015.04.018
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:Women with chronic hypertension are at increased risk for superimposed preeclampsia. We developed a prediction algorithm for superimposed preeclampsia using clinical and laboratory information that were measured early in pregnancy. STUDY DESIGN:A secondary analysis of data that were collected from 110 women ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.03.029
更新日期:2004-11-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes mellitus (GDM) and maternal and perinatal outcomes. STUDY DESIGN:We conducted a secondary analysis of a multicenter randomized treatment trial of mild GDM in whic...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ajog.2015.06.022
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVE:This study investigates the association of allelic variation in angiogenic pathway genes and preeclampsia. STUDY DESIGN:Data for cases with preeclampsia and term control subjects were collected prospectively. Maternal DNA was extracted, and 124 tagging single nucleotide polymorphisms in 6 genes (vascular end...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2010.01.040
更新日期:2010-05-01 00:00:00
abstract::The therapeutic effect of magnesium sulfate remains unknown. Its role as an anticonvulsant is controversial. The effect of pretreatment with parenteral magnesium sulfate on the ability to initiate penicillin-induced seizure foci in anesthetized cats was studied. All animals in the experimental group achieved serum mag...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90482-1
更新日期:1989-02-01 00:00:00
abstract::To determine whether abnormalities of the androgen receptor previously observed in skin fibroblasts from patients with androgen insensitivity syndrome also occur in the gonads of affected individuals, androgen receptor activity in the gonads of a patient with testicular feminization syndrome was investigated. Using co...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(84)90434-4
更新日期:1984-11-01 00:00:00
abstract:BACKGROUND:A rapid increase in restrictive abortion legislation in the United States has sparked renewed interest in self-managed abortion as a response to clinic access barriers. Yet little is known about knowledge of, interest in, and experiences of self-managed medication abortion among patients who obtain abortion ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2020.02.026
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVE:Knowledge of the stereology of human myometrium in pregnancy is limited. Uterine contractile performance may be altered in association with maternal obesity and advanced maternal age. The aim of this study was to investigate the stereology of human myometrium in pregnancy, and to evaluate a potential influenc...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.01.019
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to compare the efficacy and safety profile of prostaglandin E2 with isosorbide mononitrate for cervical ripening before the induction of labor at term. STUDY DESIGN:Primigravid women were assigned randomly to receive either 40 mg of isosorbide mononitrate or 2 mg of prostaglandi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ajog.2005.10.812
更新日期:2006-04-01 00:00:00
abstract::Nonimmune hydrops fetalis can be caused by fetal chromosomal, hematologic, cardiac, or infectious conditions. A fetal blood sample obtained from percutaneous ultrasound-guided fetal blood sampling can offer vital information about the underlying cause of nonimmune hydrops fetalis, and perinatal management can be plann...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80343-5
更新日期:1987-07-01 00:00:00
abstract:OBJECTIVE:The basic mechanisms responsible for human parturition remain to be elucidated. The influx of fetal leukocytes into the myometrium has been recently proposed to be a crucial event in the onset of murine parturition. Surfactant protein-A has been implicated in the initiation of labor. In mice, it is thought th...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.06.052
更新日期:2006-09-01 00:00:00
abstract::Identification of a 3100-year-old lithopedion in the Archaic Southwest antedates its first clinical notation by 2100 years. It was only the "autopsy" of time (excavation of the site) that allowed its presence to be brought to light. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 历史文章,杂志文章
doi:10.1016/0002-9378(93)90148-c
更新日期:1993-07-01 00:00:00
abstract::Infertility was examined among 343 diethylstilbestrol-exposed and 303 unexposed daughters whose mothers participated in an evaluation of diethylstilbestrol use during pregnancy 35 years ago. Of the married individuals who were not using contraception and who were actively trying to conceive, a greater proportion of di...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90012-9
更新日期:1988-03-01 00:00:00
abstract::The obstetric events leading to the birth of infants who developed respiratory distress syndrome (RDS) were evaluated. In a retrospective study of 100 consecutive cases it was determined that untimely or unwarranted physician intervention in the pregnancy was responsible for 15 per cent of cases and possibly responsib...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1975-11-15 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate whether the amniotic viral load of mothers with primary cytomegalovirus infection correlate with fetal or neonatal outcomes. STUDY DESIGN:Sixty-eight of 138 pregnant women with primary infection defined by immunoglobulin G seroconversion or the presence of immunoglobulin...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.106347
更新日期:2000-08-01 00:00:00
abstract::Two hundred seventy-eight high-risk patients were managed by a comprehensive assessment of the anatomic, biochemical, and functional environment of the fetoplacental unit utilizing predetermined guidelines. Decisions to terminate pregnancy were reserved for patients who demonstrated a positive OCT. Perinatal outcome i...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(79)90835-4
更新日期:1979-07-01 00:00:00
abstract:BACKGROUND:While there is an increasing trend of ovarian conservation at the time of surgical treatment for young women with stage I cervical cancer, the risk for subsequent ovarian cancer after ovarian conservation has not been well studied. OBJECTIVE:We sought to examine the incidence of and risk factors for metachr...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2017.06.019
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate endometrial biopsy and curettage in detecting small nerve fibers in eutopic endometrium for diagnosis of endometriosis. STUDY DESIGN:Endometrial biopsies with precise, consistent technique and curettings were taken from 37 women (20 with endometriosis and 17 without ...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/j.ajog.2007.04.032
更新日期:2007-12-01 00:00:00
abstract::Two infants, who presented at birth with isoimmune thrombocytopenic purpura, are the basis for this report. The problems confronting the physician in treating an affected infant, as well as in the management of subsequent pregnancies after an infant with isoimmunization has been delivered, are discussed. In view of th...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(76)90008-9
更新日期:1976-01-01 00:00:00
abstract:OBJECTIVE:The purpose of the present systematic review is to evaluate the available medical treatments for vulvar lichen sclerosus, using an arm-based network meta-analysis protocol. DATA SOURCES:We searched Medline (1966-2019), Scopus (2004-2019), Cochrane Central Register of Controlled Trials CENTRAL (1999-2019), Cl...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2019.10.095
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine whether sexual intercourse was associated with the treatment efficacy or the incidence of preterm birth in two large randomized trials in which metronidazole treatment of bacterial vaginosis or Trichomonas vaginalis did not reduce preterm birth. STUDY DESIGN:Seconda...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.127134
更新日期:2002-11-01 00:00:00
abstract::To determine the usefulness of the assays of maternal serum alpha-fetoprotein, human placental lactogen, and pregnancy-specific beta 1-glycoprotein in prenatal diagnosis of fetal alcohol syndrome, these proteins were followed in 35 problem drinkers (greater than 100 gm of ethanol weekly) and in 14 abstinent women thro...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90286-3
更新日期:1986-09-01 00:00:00
abstract::A light and electron microscopic study was undertaken of the early phases of cervical squamous metaplasia. A study of areas of columnar epithelium with one row of subcolumnar cells revealed a spectrum of squamous differentiation ranging from cytologically undifferentiation to more characteristically basal type squamou...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(15)33239-7
更新日期:1980-07-15 00:00:00