Perinatal outcome in triplet versus twin gestations

Article Abstract:

Pregnancies achieved using new reproductive technologies have a greater chance of involving more than one fetus. Until recently, information regarding the management and outcome of triplet pregnancies has been limited by the small number of triplet pregnancies available for study. The pregnancy outcome of 15 triplet pregnancies was compared with a similarly matched group of women pregnant with twins. Labor was preterm, beginning before the 37th week, in 80 percent of the triplet versus 40 percent of the twin pregnancies. Early labor resulted in preterm delivery in 87 percent of the triplet pregnancies and 26.7 percent of the twin pregnancies. Triplet infants weighed less at birth than twin infants, an average of 3.8 pounds (1,720 grams) versus 5.4 pounds (2,475 grams). The average fetal age at delivery was 32 weeks for triplet pregnancies and 36.6 weeks for twin pregnancies. Intrauterine growth retardation, the inadequate growth of a fetus, was diagnosed more often in triplet fetuses than in twin fetuses (53.3 percent versus 6.7 percent). The unequal growth of one fetus was found more often among triplet fetuses than twin fetuses (66.7 percent versus 13.3 percent). Triplet infants had a tendency to stay in the hospital longer and were admitted more often to the neonatal intensive care unit. There were no significant differences in complications in the mother or in major infant complications such as respiratory distress syndrome and brain hemorrhage, common complications of prematurity. However, for many of the complications examined, the risk was slightly greater among triplets, even though the results were not statistically significant. Overall, the risk of preterm delivery and low birth weight is greater for triplet pregnancies. This information is useful in developing management strategies for multiple pregnancies and to help make decisions for selective reduction (elimination of one or more fetuses). (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Twins, Triplets, Multiple birth

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Uterine leiomyomas in pregnancy: a prospective study

Article Abstract:

Uterine leiomyomas (benign tumors of the muscular wall of the uterus) are present in approximately one fifth of women older than 30, and often occur without symptoms. Although it is commonly believed that leiomyomas are associated with complications during pregnancy, results from controlled, prospective studies have not been reported. To learn more about this issue, pregnant women (in gestational weeks 20 to 24) with a history of uterine leiomyomas were examined with ultrasound, and any leiomyomas so detected were measured and described. Two additional ultrasound studies were performed on women with leiomyomas at planned intervals during the remainder of the pregnancy. Each patient with one or more leiomyomas was matched with another pregnant woman of similar age, race, and pregnancy history who did not have uterine leiomyomas (the control group). The results showed that 85 women had one or more leiomyomas. None developed placenta previa (abnormal location of the placenta) or placenta abruptio (sudden separation of the placenta from the uterus); one control subject developed placenta previa. Forty percent of the women with leiomyomas delivered by cesarean section, compared with 33 percent of the controls. The average gestational age was lower for the leiomyoma group than for controls (37.5 and 39.6 weeks, respectively), but there were no differences between the groups regarding premature rupture of membranes and preterm labor (before the 37th gestational week). Nor did the number of leiomyomas or their location affect pregnancy outcome. Although leiomyomas were not associated with any outcome characteristic of pregnancy, women with this condition should be told of their risk of delivering somewhat earlier than they may expect. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Pregnancy, Complications of, Pregnancy complications, Uterine tumors

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The biophysical profile in labor

Article Abstract:

Accurate diagnosis of fetal distress is essential for appropriate decision-making regarding whether to do an emergency cesarean section, but two methods in wide use, the nonstress test (NST, a measure of baseline fetal activity) and monitoring the fetal heart rate (FHR), have high rates of false-positive identification. This means that these two methods often indicate the presence of fetal distress when, in fact, none exists. It is possible that the biophysical profile (a composite measurement of fetal health) would be a good predictor of fetal health. To evaluate this, biophysical profiles were obtained for 95 deliveries of fetuses between 36 and 42 weeks' gestational age. The variables measured included fetal breathing, fetal movement, fetal tone (extension and flexion of limbs), reactive FHR, and the volume of amniotic fluid (the fluid in which the fetus floats). Correlations between these measures and neonatal blood gas concentrations were made. Acidemia (increased acidity of the blood, associated with insufficient oxygen) is a sign of fetal distress. For the 64 patients who had three determinations of biophysical profiles, no correlation between biophysical profile score at any stage of labor and fetal blood acidity was found. Acidemia was not associated with any particular biophysical profile score. The results indicate that this score would not be a worthwhile addition to FHR monitoring for diagnosing fetal distress during delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Usage, Evaluation, Diagnosis, Fetal distress, Fetal heart rate monitoring, Electronic fetal monitoring, Cesarean section, Fetal anoxia, Fetal movement, Fetal movements

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