Neonatal Outcomes of Triplet Pregnancies Conceived via In Vitro Fertilization versus Other Methods of Conception.

OBJECTIVE: This study aims to investigate neonatal outcomes of triplet gestations conceived via in vitro fertilization (IVF) compared with those not conceived by IVF. STUDY DESIGN: This is a retrospective cohort study of women who delivered a triplet gestation ≥24 weeks at a large academic center (2005-2016). Women with unknown mode of conception were excluded. Women who conceived via IVF were compared with those conceiving spontaneously or through non-IVF fertility treatments. The primary outcome was a composite severe neonatal morbidity (respiratory distress syndrome, necrotizing enterocolitis, severe intraventricular hemorrhage, retinopathy of prematurity, neonatal sepsis, or death). Bivariate comparisons were made by mode of conception and unadjusted generalized estimating equations were used to estimate odds ratios (OR) after accounting for the clustering of neonate by mother. RESULTS: Among 82 women included in this analysis, 51 (62%) conceived via IVF. Women who conceived via IVF were older (35.2 vs. 30.7, p < 0.001) and more likely to be of non-Hispanic white race/ethnicity (91.8 vs. 70.0%, p < 0.01) and married (100 vs. 90.0%, p = 0.02) when compared with women who did not conceive via IVF. Although women who conceived via IVF delivered at an earlier gestational age than those who did not (32.9 ± 3.0 vs. 33.7 ± 2.6 weeks, p = 0.02), there was no significant difference in composite neonatal morbidity (34.0 vs. 28.0%, p = 0.32; OR: 1.33, 95% CI: 0.60-2.91). Additionally, there were no significant differences between the groups with regard to other neonatal outcomes examined, including fetal growth restriction, birthweight, umbilical artery pH <7, neonatal intensive care unit admissions, duration in the NICU, need for mechanical ventilation, or duration of mechanical ventilation. CONCLUSION: Neonatal outcomes among triplet gestations did not differ by IVF in this well-characterized, single-center cohort.

The Association between Cervical Exam after Ripening with Foley Balloon Catheter and Outcomes of Nulliparous Labor Induction.

OBJECTIVE: Evaluate the association between cervical examination after ripening with Foley catheter and labor induction outcomes. MATERIALS AND METHODS: In this retrospective cohort, nulliparous women with singleton, viable gestation undergoing cervical ripening with Foley catheter were compared based on cervical status after catheter removal or expulsion: favorable (modified Bishop score ≥ 5) or unfavorable (score < 5). Bivariable and multivariable analyses were performed to determine whether cervical examination postripening was associated with time to delivery and chance of vaginal delivery. RESULTS: A total of 774 women were eligible. Women with favorable examination postripening had lower body mass index (BMI) and more favorable admission cervical examination. The frequency of vaginal delivery was higher in women with favorable cervical examination postripening (57.9% versus 46.8%, p < 0.01). Median durations from Foley removal or expulsion to complete dilation (8.6 h versus 11.5 h) and vaginal delivery (10.4 h versus 13.2 h) were shorter for women with favorable cervical examination postripening (p < 0.001). In multivariable analysis, favorable examination postripening remained associated with vaginal delivery (adjusted odds ratio 1.39, 95% confidence interval 1.04-1.87), and time to vaginal delivery (adjusted hazard ratio 1.39, 95% confidence interval 1.13-1.70). CONCLUSION: A favorable modified Bishop score after cervical ripening with Foley balloon catheter is associated with higher chance of vaginal delivery and shorter labor duration.

Evaluation of Trichorionic versus Dichorionic Triplet Gestations from 2005 to 2016 in a Large, Referral Maternity Center.

Objective To evaluate trends in the proportions and outcomes of dichorionic-triamniotic (DT) compared with trichorionic-triamniotic (TT) triplet gestations. Methods This is a retrospective cohort of all triplet gestations identified by first trimester ultrasound at an academic center between 2005 and 2016. Primary outcomes were the change in proportion of DT versus TT triplets over time and the number of fetuses at delivery. Secondary outcomes included differences in mode of conception and maternal/perinatal outcomes by chorionicity. Results Of 258 identified triplet pregnancies, 65.5% (n = 169) were TT. The proportion of DT versus TT triplets increased from 2005 to 2016 (p < 0.001). Women with DT triplets were more likely to deliver a singleton (41.4 vs. 11.2%, p < 0.001). Mode of conception was known for 248 women, of whom 93.5% (n = 232) conceived through infertility treatment. Types of infertility treatment differed by chorionicity (p < 0.001), with DT triplets more likely to conceive through in vitro fertilization (88.3 vs. 60.7%). Women with DT delivered earlier than TT triplets (31.0 ± 5.0 vs. 33.1 ± 3.5 weeks; p = 0.03). Conclusion The proportion of DT triplet gestations increased significantly over time. Women with DT triplets delivered on average 2 weeks earlier than TT triplets. Women with DT triplets were more likely to reduce to a singleton gestation.

Association of Early Amniotomy After Foley Balloon Catheter Ripening and Duration of Nulliparous Labor Induction.

OBJECTIVE: To evaluate the association between early amniotomy after ripening with a Foley balloon catheter and duration of labor induction. METHODS: In this retrospective matched cohort study, 546 nulliparous women with a singleton viable gestation undergoing cervical ripening with a Foley balloon catheter were compared based on timing of amniotomy after catheter removal: early (defined as artificial rupture of membranes less than 1 hour after Foley removal) compared with no artificial rupture of membranes in the first hour. Women in the early amniotomy group were matched to women in the control group according to health care provider type, cervical examination after Foley removal, and indication for induction in a one-to-one ratio. Bivariable and multivariable analyses were performed to determine whether early amniotomy was associated with vaginal delivery within 24 hours and other adverse maternal and neonatal outcomes. Cox proportional hazard regression was used to compare time intervals from catheter removal to complete dilation and from catheter removal to delivery. RESULTS: In univariable analysis, the frequency of vaginal delivery within 24 hours of Foley placement was higher in women with early amniotomy (42.9% compared with 33.0%, P=.02). The median time intervals from Foley catheter removal to complete dilation (9.0 hours compared with 12.1 hours) and to delivery (10.6 hours compared with 13.8 hours) were also significantly shorter for women who underwent early amniotomy (P<.001 for both). There were no significant differences in any other adverse maternal or neonatal outcomes. In multivariable analysis, early amniotomy remained associated with higher odds of vaginal delivery within 24 hours and shorter times from catheter removal to complete dilation and to delivery. CONCLUSION: Early amniotomy after Foley balloon catheter removal is associated with shorter duration of labor induction among nulliparous women.