ABSTRACT
OBJECTIVE: To estimate the risk for twin anemia-polycythemia sequence (TAPS) and adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancies with amniotic fluid discordance (AFD). METHODS: Retrospective cohort study of 34 MCDA pregnancies with AFD (intertwin difference of ≥3 cm in maximal vertical pocket measurement) without meeting the criteria for twin to twin transfusion syndrome or selective intrauterine growth restriction. Perinatal outcome measures and the risk for TAPS were compared with a control group consisted of 101 MCDA twin pregnancies without AFD, twin to twin transfusion syndrome, or selective intrauterine growth restriction. Composite neonatal morbidity was defined as the presence of respiratory distress syndrome, intraventricular hemorrhage grades 3 and 4, necrotizing enterocolitis or sepsis. RESULTS: Overall, in the AFD group, seven twin pairs (20.6%) were complicated by TAPS compared with none in the controls (p < 0.001). In the AFD group, women who developed TAPS had significantly higher AFD compared with women who did not develop TAPS (7.3 cm vs 4.2 cm, p < 0.01). Patients in the AFD group delivered earlier (34.6 vs 35.8 weeks, p < 0.001) and had significantly higher rate of composite neonatal morbidity compared with the control group (13.2 vs 2.5%, p = 0.002). CONCLUSIONS: Despite the overall favorable outcome, MCDA twins with AFD are at increased risk for developing TAPS. © 2016 John Wiley & Sons, Ltd.
Subject(s)
Cerebral Hemorrhage/epidemiology , Enterocolitis, Necrotizing/epidemiology , Fetofetal Transfusion/epidemiology , Neonatal Sepsis/epidemiology , Oligohydramnios/epidemiology , Polyhydramnios/epidemiology , Pregnancy, Twin , Respiratory Distress Syndrome, Newborn/epidemiology , Twins, Monozygotic , Adult , Amniotic Fluid/diagnostic imaging , Case-Control Studies , Female , Fetofetal Transfusion/diagnosis , Fetofetal Transfusion/diagnostic imaging , Humans , Infant, Newborn , Male , Oligohydramnios/diagnostic imaging , Polyhydramnios/diagnostic imaging , Pregnancy , Retrospective Studies , Ultrasonography, PrenatalABSTRACT
OBJECTIVE: To determine the safety and efficacy of labor induction with low-dose vaginal prostaglandin E2 (PGE2) in grandmultiparous women with a previous cesarean delivery. METHODS: We conducted a retrospective cohort study of 219 grandmultiparous women with a previous cesarean delivery (study group) who underwent induction of labor with low dose PGE2. These patients were compared to 1376 grandmultiparous women without a previous cesarean section (control group) who underwent induction of labor with low dose PGE2. The primary outcome was uterine rupture and secondary outcomes included mode of delivery, post-partum hemorrhage (PPH) and a low 5-min Apgar score (≤7). RESULTS: One patient in the study group as well as one patient in the control group were diagnosed with uterine rupture (0.4% versus 0.07%). In the study group, vaginal delivery was achieved in 204 (93.16%) patients, whereas 15 (6.84%) patients had emergent cesarean delivery. Five minutes Apgar score ≤7 was recorded in two cases (0.9%) in the study group. Patients in the study group had a significantly higher rate of cesarean delivery (6.84%, versus 3.4%, respectively, p < 0.001) as well as operative vaginal delivery (4.56% versus 2% respectively, p < 0.05) compared to the control group. There were no significant differences between the groups regarding the rate of PPH (0.91% versus 0.90%, p = 0.2) or 5-min Apgar score ≤7 (0.91% versus 0.22%, p = 0.28). CONCLUSIONS: Low dose PGE2 is a relative safe method for induction of labor in grandmultiparous women with a previous cesarean section.
Subject(s)
Dinoprostone/administration & dosage , Dinoprostone/adverse effects , Labor, Induced/methods , Oxytocics/administration & dosage , Oxytocics/adverse effects , Parity , Vaginal Birth after Cesarean , Administration, Intravaginal , Adult , Case-Control Studies , Dose-Response Relationship, Drug , Female , Humans , Labor, Induced/adverse effects , Labor, Induced/statistics & numerical data , Middle Aged , Parity/drug effects , Pregnancy , Pregnancy Outcome/epidemiology , Retrospective Studies , Treatment Outcome , Uterine Rupture/epidemiology , Vaginal Birth after Cesarean/adverse effects , Vaginal Birth after Cesarean/methods , Vaginal Birth after Cesarean/statistics & numerical dataABSTRACT
OBJECTIVE: The aim of this study was to assess the safety of labor induction with vaginal prostaglandin E2 (PGE2) in grandmultiparous women. METHODS: We conducted a retrospective cohort study of 1376 grandmultiparous women who underwent induction of labor with low dose PGE2. The primary outcome was uterine rupture and secondary outcomes included mode of delivery, postpartum hemorrhage and five minutes Apgar score. RESULTS: One case was diagnosed with uterine rupture (0.07%). Vaginal delivery was achieved in 1329 (96.6%) patients, whereas 47 (3.4%) patients had emergent cesarean delivery. Five minutes Apgar score ≤7 was recorded in three cases (0.2%). There was no correlation between parity and cesarean delivery rate or low Apgar score. There were no significant differences between the grandmultiparous and great-grandmultiparous patients regarding cesarean delivery rate (3.1 vs. 5%, P = 0.12), operative vaginal delivery rate (2 vs. 2.3%, P = 0.74) or postpartum hemorrhage rate (0.8 vs. 1.1%, P = 0.6). CONCLUSIONS: Low dose PGE2 is a safe and efficient method for induction of labor in grandmultiparous and great-grandmultiparous women.
