The purpose of this study was to evaluate the impact of routine hospitalization for fetal monitoring on the perinatal survival and neonatal morbidity of monoamniotic twins. This was a multicenter retrospective cohort ...The purpose of this study was to evaluate the impact of routine hospitalization for fetal monitoring on the perinatal survival and neonatal morbidity of monoamniotic twins. This was a multicenter retrospective cohort analysis of 96 monoamniotic twin gestations from 11 university and private perinatal practices. Overall mortality rates were calculated. The risk of intrauterine fetal death and neonatal morbidity was compared among women who were observed as inpatients versus outpatients. The overall mortality rate from enrollment was 19.8% (mean gestational age at enrollment, 17.4 weeks). The perinatal mortality and corrected perinatal mortality rates were 15.4% and 12.6% , respectively. Eighty- seven women had both twins who were surviving at 24 weeks of gestation; 43 women were admitted electively for inpatient surveillance at a median gestational age of 26.5 weeks; the remainder of the women were followed as outpatients and admitted only for routine obstetric indications (median gestational age, 30.1 weeks). No intrauterine fetal deaths occurred in any hospitalized patient. The risk of intrauterine fetal death in women who were followed as outpatients was 14.8% (13/88) versus 0 for women who were followed as inpatients (P <. 001). There also were statistically significant improvements in birth weight, gestational age at delivery, and neonatal morbidity for women who were followed as inpatients. We observed improved neonatal survival and decreased perinatal morbidity among women who were admitted electively for inpatient fetal monitoring.展开更多
Increasing numbers of mature women are achieving pregnancy largely through assisted reproductive technology (ART). Our Objective was to investigate women over 45 years of age to determine the impact of pregnancy compl...Increasing numbers of mature women are achieving pregnancy largely through assisted reproductive technology (ART). Our Objective was to investigate women over 45 years of age to determine the impact of pregnancy complications on newborn outcome. A study of women older than 45 years at their estimated date of confinement (EDC) was compared with a control group under 36 years at their EDC, matched by parity and plurality. All study patients and controls received uniform obstetric management through a single maternal fetal practice. The primary outcome was gestational age at birth stratified by plurality; secondary outcomes included birth weight, NICU days, composite neonatal morbidity, and a variety of obstetric complications. Wilcoxon signed rank and McNemar’ s tests were used as appropriate; logistic regression was used to calculate odds ratios (ORs) and CIs. Statistical significance was assumed for P <.05. Fifty study and control patients were identified over a 5- year period. Study patients were older than controls, but the difference in "gamete" age was not significant. There was significantly more assisted reproduction (donor egg) and preeclampsia among study patients. Importantly, gestational age at birth and birth weights stratified by plurality were not different (86% power to detect 2- week gestational age difference, alpha 0.05). Hospital days, NICU days, and composite neonatal morbidity were not different between study patients and controls. When controlled for parity and plurality, mature women over 45 years conceiving largely through ART with donor eggs can expect newborn outcomes similar to younger women cared for in the same setting of a high- risk maternal- fetal practice.展开更多
文摘The purpose of this study was to evaluate the impact of routine hospitalization for fetal monitoring on the perinatal survival and neonatal morbidity of monoamniotic twins. This was a multicenter retrospective cohort analysis of 96 monoamniotic twin gestations from 11 university and private perinatal practices. Overall mortality rates were calculated. The risk of intrauterine fetal death and neonatal morbidity was compared among women who were observed as inpatients versus outpatients. The overall mortality rate from enrollment was 19.8% (mean gestational age at enrollment, 17.4 weeks). The perinatal mortality and corrected perinatal mortality rates were 15.4% and 12.6% , respectively. Eighty- seven women had both twins who were surviving at 24 weeks of gestation; 43 women were admitted electively for inpatient surveillance at a median gestational age of 26.5 weeks; the remainder of the women were followed as outpatients and admitted only for routine obstetric indications (median gestational age, 30.1 weeks). No intrauterine fetal deaths occurred in any hospitalized patient. The risk of intrauterine fetal death in women who were followed as outpatients was 14.8% (13/88) versus 0 for women who were followed as inpatients (P <. 001). There also were statistically significant improvements in birth weight, gestational age at delivery, and neonatal morbidity for women who were followed as inpatients. We observed improved neonatal survival and decreased perinatal morbidity among women who were admitted electively for inpatient fetal monitoring.
文摘Increasing numbers of mature women are achieving pregnancy largely through assisted reproductive technology (ART). Our Objective was to investigate women over 45 years of age to determine the impact of pregnancy complications on newborn outcome. A study of women older than 45 years at their estimated date of confinement (EDC) was compared with a control group under 36 years at their EDC, matched by parity and plurality. All study patients and controls received uniform obstetric management through a single maternal fetal practice. The primary outcome was gestational age at birth stratified by plurality; secondary outcomes included birth weight, NICU days, composite neonatal morbidity, and a variety of obstetric complications. Wilcoxon signed rank and McNemar’ s tests were used as appropriate; logistic regression was used to calculate odds ratios (ORs) and CIs. Statistical significance was assumed for P <.05. Fifty study and control patients were identified over a 5- year period. Study patients were older than controls, but the difference in "gamete" age was not significant. There was significantly more assisted reproduction (donor egg) and preeclampsia among study patients. Importantly, gestational age at birth and birth weights stratified by plurality were not different (86% power to detect 2- week gestational age difference, alpha 0.05). Hospital days, NICU days, and composite neonatal morbidity were not different between study patients and controls. When controlled for parity and plurality, mature women over 45 years conceiving largely through ART with donor eggs can expect newborn outcomes similar to younger women cared for in the same setting of a high- risk maternal- fetal practice.
