Modifiable risk factors for growth restriction in twin pregnancies.

OBJECTIVE: This study was undertaken to evaluate modifiable risk factors for adverse fetal growth in twin pregnancies. STUDY DESIGN: A large cohort study from a database of women with twin gestations identified at risk for preterm labor was performed. Examining each infant's birth weight and gestational age at delivery, infants were classified as being average (AGA), large (LGA), or small (SGA) for gestational age, using the Alexander reference curve. Clinical and demographic factors were compared between patients delivering at least 1 SGA infant and AGA pairs using Pearson's chi2 Student t test statistics and logistic regression. RESULTS: There were 11,827 twin pregnancies evaluated. Risk factors associated with SGA deliveries included tobacco abuse, poor weight gain, lean prepregnancy body mass index, African American race, and nonmarried. The logistic regression identified tobacco abuse as the single greatest risk for poor fetal growth, (odds ratio [OR] 1.95; 95% CI [1.68, 2.27]). Weight gain of less than one-half lb/wk also increased SGA risk (OR 1.35; 95% CI [1.16, 1.68]), whereas weight gain greater than 1 lb/wk decreased SGA risk (OR 0.77; 95% CI [0.68, 0.86]). CONCLUSION: Tobacco abuse and weight gain are the modifiable risk factors, which require intervention during a twin pregnancy. Patients should be encouraged to stop tobacco abuse and gain a minimum of one-half lb/wk in the later half of pregnancy to minimize the risk for growth restriction.

Factors influencing maternal perception of uterine contractions.

OBJECTIVES: The purpose of this study was to assess factors associated with perception of uterine contractions. STUDY DESIGN: A database of ambulatory uterine activity monitoring was examined. All patients having singleton pregnancies evaluated between March 1997 and March 2002 were eligible for analysis. Data were divided into 4 groups by maternal prepregnancy body mass index (BMI): lean (<20 kg/m(2)), normal (>or=20 to <25 kg/m(2)), overweight (>or=25 to <30 kg/m(2)), and obese (>or=30 kg/m(2)). The percentage of contractions perceived during observation was compared between groups. Variables interrogated included maternal weight and parity. Statistical analysis included t test, analysis of variance (ANOVA), and linear regression. RESULTS: Data from 7808 patients (556,382 hr) were analyzed. A significant reduction in perception of contractions occurred with increasing BMI between each classification, P <.001. A significant reduction in perception of contractions was also noted between nulliparous and multiparous patients at each weight classification, P <.001. CONCLUSION: Obese, nulliparous patients have the greatest difficulty perceiving contractions. Such data may help explain unattended birth or late presentation for care in this group.

An aggressive interventional protocol for early midtrimester premature rupture of the membranes using gelatin sponge for cervical plugging.

OBJECTIVE: This study was performed to evaluate a protocol for treatment of previable premature rupture of membranes (PROM) that includes the administration of gelatin sponge to retard the loss of fluid from the amniotic cavity. STUDY DESIGN: Women with PROM at or=24 weeks, 53%), with six of these newborn infants surviving to hospital discharge (30%) and two suffering intrauterine death. The average gestational age of delivery for survivors was 31.8 +/- 4.3 weeks, range 25 to 36 weeks. Talipes equivarus was observed in three survivors (50%). Bilateral hip dysplasia and torticollis were also diagnosed in two infants. Respiratory distress syndrome was diagnosed in all cases delivered at less than 32 weeks but was not observed thereafter. No adverse sequelae have been attributed to gelatin sponge exposure. CONCLUSION: The observed survival rate with this interventional approach in a population at highest risk for pregnancy loss justifies further study of this treatment strategy. This protocol may not reduce the rate of musculoskeletal abnormalities.

Gelatin sponge embolization. a method for the management of iatrogenic preterm premature rupture of the membranes.

Despite the morbidity and mortality associated with early midtrimester premature rupture of the membranes (PROM), limited therapeutic options currently exist for its treatment. A new operative approach to this condition termed embolization involves intra-uterine administration of a gelatin sponge which can remarkably reduce or eliminate further loss of amniotic fluid. A successful case of embolization for the treatment of iatrogenic previable PROM complicating therapeutic fetoscopy is described.