ABSTRACT
Advances in neonatal care improved the survival of many preterm infants, but also increased the incidence of retinopathy of prematurity (ROP). Numerous risk factors have been associated with the development of ROP, the most important of which are: low birth weight, early gestational age at delivery, and duration of oxygen therapy. Screening premature infants is a critical factor for any prevention and treatment protocol. The Retinopathy of Prematurity Subcommittee of the American Academy of Ophthalmology (AAO) and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) have developed guidelines that assist practicing physicians in managing children with ROP. A portion of these guidelines is particularly applicable to practicing obstetricians who, along with the pediatricians, are often the primary physicians for the affected families. The aim of this paper is to present a comprehensive overview of the epidemiology, etiology, manifestations, prevention, and management of ROP. In the last section, the authors present guidelines for practicing obstetricians that incorporate the most recent recommendations of ophthalmic and pediatric thought leaders.
Subject(s)
Neonatal Screening/methods , Retinopathy of Prematurity/diagnosis , Retinopathy of Prematurity/therapy , Vision Screening/methods , Child , Humans , Infant , Infant, Newborn , Infant, Premature , Mass Screening/methods , Practice Guidelines as Topic/standards , Practice Patterns, Physicians'/organization & administration , Retinopathy of Prematurity/epidemiology , Retinopathy of Prematurity/prevention & controlABSTRACT
The study of multiple gestations in older mothers has been furthered by the analyses of large data sets published in recent years. These initial analyses are counterintuitive in that the obstetric and neonatal outcomes of the older mothers (>40 years) are better than those of their younger counterparts (aged 25-29). Currently, it is not clear if older mothers of multiples are advantaged or younger mothers of multiples are disadvantaged. It seems reasonable, however, to conclude that pregnancy after age 40 represents a new obstetric entity, one in which many women will have twins or triplets as a result of assisted reproductive technologies. Further study in this area is clearly warranted, preferably using databases that combine maternal and neonatal data.
Subject(s)
Maternal Age , Pregnancy Outcome , Pregnancy, Multiple , Adult , Aging , Birth Weight , Female , Gestational Age , Humans , Middle Aged , Parity , Pregnancy , TripletsABSTRACT
Triplet pregnancies are by nature rare. Assisted reproductive technologies have multiplied their rate of occurrence in the last two decades. Whether spontaneous or induced, triplet pregnancies present obstetric and neonatal-and then often lifelong-medical problems severalfold more often than singletons, or even twins. The major cause of problems for triplet gestations stems from preterm delivery and low birth weight.
