Clinical factors affecting the timing of delivery in twin pregnancies

OBJECTIVE: To investigate clinical factors affecting the timing of delivery in twin pregnancies in order to minimize perinatal complications. METHODS: A retrospective study involved 163 twin pregnancies delivered from January 2006 to September 2011 at Gachon University Gil Medical Center. These cases were divided into three groups based on the delivery timing: less than 32 weeks' gestation (group A), between 32 and 35+6 weeks' gestation (group B), and over 36 weeks' gestation (group C). Clinical factors including maternal age, parity, presence of premature uterine contraction, presence of premature rupture of membrane, white blood cell, high sensitive C-reactive protein level, cervical dilatation, maternal complication, chorionicity, twin specific complication, and perinatal complication were analyzed for each group. RESULTS: In group B, the timing of delivery was postponed for 14 days or more from the time of admission, and there were fewer numbers of babies with low Apgar score at birth compared with other groups. The frequency of uterine contraction (P<0.001), presence of premature rupture of membranes (P=0.017), dilatation of cervix (P<0.001), increased white blood cell and high sensitive C-reactive protein levels (P=0.002, P<0.001) were important clinical factors during decision making process of delivery timing in twin pregnancies. Twin specific fetal conditions, such as twin-twin transfusion syndrome and discordant growth (over 25% or more) were shown more frequently in group A. However, there were no significant statistical differences among three groups (P=0.06, P=0.14). CONCLUSION: Proper management for preventing premature contraction and inflammation can be essential in twin pregnancies until 32 weeks' gestation, and may decrease maternal and perinatal complications.

Differences in Maternal Hair Heavy Metal and Mineral Levels between Preterm Delivery and Full-term Delivery / 대한주산의학회잡지

OBJECTIVES: Previous studies on the effects of heavy metal exposure on adverse birth outcomes are still inconsistent. Heavy metal exposure would be related to decreased birth weight and a shortened gestational age. The aim of this work was to investigate maternal hair heavy metal concentrations in relation to gestational age at delivery. METHODS: A total of 52 maternal hair samples were collected at the department of Obstetrics and Gynecology, Gil hospital, Korea. Delivery before 37 weeks of gestation was defined as preterm and delivery after 37 weeks of gestation was defined as full-term delivery. We gathered the specimens from maternal hair approaching delivery. 23 samples were taken from preterm delivered mothers and 29 samples from full term delivered mothers. We evaluated maternal specimen by hair tissue mineral analysis to measure heavy metal concentrations accumulated for more than several months. All statistical analyses were performed with Chi-square test, Mann-Whitney U test and Wilcoxon W test. RESULTS: Heavy metal was revealed in pregnant women's hair but there was not a significant correlation between levels of heavy metal and gestational age at delivery. Compared numbers of preterm delivery and full-term delivery by stratified by heavy metal concentrations did not have significant correlation. CONCLUSIONS: This study does not show any strong relationship between delivery outcome and heavy metal measured by hair tissue mineral analysis. Further prospective studies with serial measures of cord blood heavy metal level and hair its levels may be required.

The effectiveness of antiemetics in hyperemesis gravidarum / 대한산부인과학회지

Nausea and vomiting occur in up to 80% of normal pregnancies. Hyperemesis gravidarum, resulting in dehydration and ketonuria, is a more severe and disabling condition affecting up to 1.5% of pregnancies. This condition is poorly understood and treatment strategies remain largely supportive with the aims of relieving symptoms and preventing complications of the disease. Treatment is supportive with intravenous hydration, antiemetics and correction of vitamin deficiency to minimize complications. There are good data to support the safety and usefulness of some kinds of antiemetics such as antihistamine, phenothiazines metoclopromide and specific HHT3 antagonists in hyperemesis gravidarum. But there is little evidence on which to choose the optimum therapy. This review discusses the diagnosis and management of hyperemesis gravidarum and the prevention, recognition and treatment of the serious complication

Comparison of birth-weight between diabetic and non-diabetic pregnant women based on gestational weeks / 대한산부인과학회지

OBJECTIVE: The risk of macrosomia in diabetic complicated pregnancy is increased perinatal morbidity. But it is difficult to predict adverse outcomes after birth with conventional diagnostic tools of diabetes in pregnant women. We evaluated the birth-weight between diabetic and non-diabetic pregnant women based on gestational weeks to determine adverse pregnancy outcome. METHODS: We selected 166 diabetic complicated pregnant women delivered between January 2005 and December 2008 and 248 non-diabetic pregnant women at same period. We compared the birth-weight between two groups in relation to the gestational age below and over 37 weeks. Fetal anomalies, fetal death, and multifetal pregnancy were excluded in this study. And we also evaluated the incidence of baby who had birth-weight 3.8 kg or more and their neonatal outcomes between two groups. RESULTS: There were 4.9% (166/3404) of diabetic complicated pregnancies. The preterm births (birth before 37 weeks of gestation) were occurred 32.5% (54/166) and term births (birth after 37 weeks of gestation) were 67.5% (112/166). The mean birth-weight in preterm birth showed 2,492 g of gestational diabetes, 3,315 g of pregestational diabetes and 2,118 g of control group (P=0.001). The mean birth-weight and gestational age at delivery in term birth showed pregestational diabetes and gestational diabetes were heavier and shorter than those of control group (P=0.002). The incidence of 3.8 kg or more of birth-weighted baby appeared 43.5% (10/23) of pregestional diabetes, 16.8% (24/143) of gestational diabetes and 8.5% (21/248) of control group (P=0.000). The Apgar score less than 7 at minutes of neonate were more frequent in pregestational and gestational diabetes than that of control group (P=0.013). CONCLUSION: It is important to classify the type of diabetes during pregnancy and there should be needed to predict adverse pregnancy outcomes including macrosomia.

Intrauterine Growth Curve of Twins on the Basis of Gestational Age / 대한산부인과학회잡지

OBJECTIVE: In order to investigate more accurate patterns of intrauterine growth in twin fetuses, we constructed the twin-specific growth curve based on gestational age in live-born non-anomalous infants. METHODS: 563 twin pairs, 1,126 infants delivered between January 1994 and October 1999 were comprised our study population. The newborns were grouped according to gestational age and the median, 10th, 50th, and 90th percentile birth weight for each gestational week were calculated. Curves were plotted for the general population and for each gender and parity and compared with previously reported singleton's growth curve. RESULTS: After 32 weeks gestation, birth weight of twins falls below that of singleton, so that by 38 weeks the 50th percentile for twins falls below the singleton 10th percentile. This difference was also present among all subgroups of twins, such as gender and parity. And the mean birth weight in male twin infant was heavier than in female twin infant throughout all gestational week. CONCLUSION: The pattern of growth in twin infants differed from those of singleton. We recommend twin-specific growth curve for clinical use in the management of twin gestations.