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[PMID]:28832490
[Au] Autor:Committee on Ethics
[Ti] Título:Committee Opinion No. 719: Multifetal Pregnancy Reduction.
[So] Source:Obstet Gynecol;130(3):e158-e163, 2017 09.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Although not all multifetal pregnancies occur after the use of assisted reproductive technology, fertility treatments have contributed significantly to the increase in multifetal pregnancies. In almost all cases, it is preferable to avoid the risk of higher-order multifetal pregnancy by limiting the number of embryos to be transferred or by cancelling a gonadotropin cycle when the ovarian response suggests a high risk of a multifetal pregnancy. When multifetal pregnancies do occur, incorporating the ethical framework presented in this Committee Opinion will help obstetrician-gynecologists counsel and guide patients as they make decisions regarding continuing or reducing their multifetal pregnancies.
[Mh] Termos MeSH primário: Redução de Gravidez Multifetal/normas
[Mh] Termos MeSH secundário: Feminino
Ginecologia
Seres Humanos
Obstetrícia
Gravidez
Sociedades Médicas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002302


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[PMID]:28832481
[Ti] Título:Committee Opinion No. 719 Summary: Multifetal Pregnancy Reduction.
[So] Source:Obstet Gynecol;130(3):670-671, 2017 Sep.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Although not all multifetal pregnancies occur after the use of assisted reproductive technology, fertility treatments have contributed significantly to the increase in multifetal pregnancies. In almost all cases, it is preferable to avoid the risk of higher-order multifetal pregnancy by limiting the number of embryos to be transferred or by cancelling a gonadotropin cycle when the ovarian response suggests a high risk of a multifetal pregnancy. When multifetal pregnancies do occur, incorporating the ethical framework presented in this Committee Opinion will help obstetrician-gynecologists counsel and guide patients as they make decisions regarding continuing or reducing their multifetal pregnancies.
[Mh] Termos MeSH primário: Redução de Gravidez Multifetal/normas
[Mh] Termos MeSH secundário: Feminino
Ginecologia
Seres Humanos
Obstetrícia
Gravidez
Sociedades Médicas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002292


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[PMID]:28483844
[Au] Autor:Razaz N; Avitan T; Ting J; Pressey T; Joseph KS
[Ad] Endereço:Department of Obstetrics and Gynaecology (Razaz, Pressey, Joseph), University of British Columbia, and BC Women's Hospital and Health Centre, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Razaz), Karolinska University Hospital in Solna, Karolinska Institutet, Stockholm, Sweden;
[Ti] Título:Perinatal outcomes in multifetal pregnancy following fetal reduction.
[So] Source:CMAJ;189(18):E652-E658, 2017 May 08.
[Is] ISSN:1488-2329
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There is currently insufficient evidence regarding the prognosis of multifetal pregnancy following elective fetal reduction to twin or singleton pregnancy. We compared perinatal outcomes in pregnancies with and without fetal reduction. METHODS: We used data on all stillbirths and live births in British Columbia, Canada, from 2009 to 2013. We compared outcomes of multifetal pregnancies with fetal reduction (to twin or singleton pregnancy) with outcomes of pregnancies without fetal reduction. The primary outcome was a composite of serious neonatal morbidity or perinatal death. Other outcomes studied included preterm birth, low birth weight and small-for-gestational-age live birth. RESULTS: The rate of serious neonatal morbidity or perinatal death did not differ significantly between pregnancies reduced to twins and unreduced triplet pregnancies (adjusted rate ratio 0.50, 95% confidence interval [CI] 0.24-1.07) or between pregnancies reduced to singletons and unreduced twin pregnancies (adjusted rate ratio 1.57, 95% CI 0.74-3.33). The rate was significantly lower in the fetal reduction group reduced to twins versus unreduced triplet pregnancies when we restricted the analysis to pregnancies conceived following the use of assisted reproduction technologies (adjusted rate ratio 0.35, 95% CI 0.18-0.67). The rates of preterm birth, very preterm birth, low birth weight and very low birth weight were significantly lower among pregnancies reduced to twins than among unreduced triplet pregnancies. Compared with unreduced twin pregnancies, pregnancies reduced to singletons had lower rates of preterm birth and low birth weight. INTERPRETATION: Fetal reduction to twins and singletons was not associated with a decreased risk of serious neonatal morbidity or perinatal death. However, such fetal reduction was associated with substantial improvements in several other perinatal outcomes, such as preterm birth and low birth weight. Clinicians discussing the risks associated with multifetal pregnancy should counsel parents on the potential risks and benefits of fetal reduction.
[Mh] Termos MeSH primário: Resultado da Gravidez
Redução de Gravidez Multifetal
Gravidez de Gêmeos
Nascimento Prematuro/epidemiologia
Técnicas de Reprodução Assistida
[Mh] Termos MeSH secundário: Adulto
Peso ao Nascer
Colúmbia Britânica
Feminino
Idade Gestacional
Seres Humanos
Recém-Nascido
Modelos Lineares
Masculino
Análise Multivariada
Gravidez
Estudos Retrospectivos
Medição de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170517
[Lr] Data última revisão:
170517
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170510
[St] Status:MEDLINE
[do] DOI:10.1503/cmaj.160722


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[PMID]:28355686
[Au] Autor:Chen QL; Ye H; Ding XY; Shen XL; Huang GN
[Ad] Endereço:Chongqing Reproductive and Genetic Institute, Chongqing Obstetrics and Gynecology Hospital, Chongqing 400013, China.
[Ti] Título:[Retrospective analysis of outcomes of selectively or spontaneously reduced multiple pregnancies out of 6 917 in vitro fertilization-embryo transfer pregnancy cycles].
[So] Source:Zhonghua Fu Chan Ke Za Zhi;52(3):159-163, 2017 Mar 25.
[Is] ISSN:0529-567X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To analyze the effects of fetal reduction in early pregnancy on obstetric and neonatal outcomes of spontaneously or selectively reduced multiple pregnancies produced by in vitro fertilization-embryo transfer (IVF-ET). Retrospective study of 6 917 clinical pregnancies from IVF-ET cycles, including 754 multiple pregnancies divided into two groups according to the remaining fetus number: reduced singleton group ( 599) and reduced twin group ( 155); and maternal and neonatal outcomes of two groups were compared to primary singleton group ( 3 589) and primary twin group ( 2 574). The rate of pregnancy complication [9.85%(59/599) versus 6.21%(223/3 589)], preterm birth [19.37%(116/599) versus 10.73%(385/3 589)], low birth weight [9.71%(56/577) versus 4.57% (152/3 324)], perinatal death [0.69%(4/577) versus 0.12%(4/3 324)] and malformation [2.95%(17/577) versus 1.02%(34/3 324)] in reduced singleton group were significantly higher than those in primary singleton group (all 0.01). There were no significant differences between reduced twin group and primary twin group (all 0.05). In reduced singleton group, birth defect rate was 2.95%, which was higher than those of the other three groups ( 0.05), in this group spontaneous pregnancy reduction accounted for 89.3% (535/599). (1) The rate of pregnancy complication, preterm birth, low birth weight, perinatal death and malformation in reduced singleton group are still higher than primary singletons, suggesting embryo reduction only is a compensated method in multiple pregnancies. Limiting the number of embryos transferred is the essential solution. (2) The rate of birth defect in spontaneous pregnancy reduction group is higher, so prenatal examination should be reinforced in this group.
[Mh] Termos MeSH primário: Transferência Embrionária
Fertilização In Vitro
Resultado da Gravidez
Redução de Gravidez Multifetal
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Recém-Nascido de Baixo Peso
Recém-Nascido
Gravidez
Complicações na Gravidez
Gravidez Múltipla
Nascimento Prematuro
Estudos Retrospectivos
Gêmeos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170630
[Lr] Data última revisão:
170630
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170330
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-567X.2017.03.004


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[PMID]:28314387
[Au] Autor:Abou Chaar MK; Meyers ML; Tucker BD; Galan HL; Liechty KW; Crombleholme TM; Marwan AI
[Ad] Endereço:Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.
[Ti] Título:Twin pregnancy complicated by esophageal atresia, duodenal atresia, gastric perforation, and hypoplastic left heart structures in one twin: a case report and review of the literature.
[So] Source:J Med Case Rep;11(1):64, 2017 Mar 18.
[Is] ISSN:1752-1947
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The antenatal diagnosis of a combined esophageal atresia without tracheoesophageal fistula and duodenal atresia with or without gastric perforation is a rare occurrence. These diagnoses are difficult and can be suspected on ultrasound by nonspecific findings including a small stomach and polyhydramnios. Fetal magnetic resonance imaging adds significant anatomical detail and can aid in the diagnosis of these complicated cases. Upon an extensive literature review, there are no reports documenting these combined findings in a twin pregnancy. Therefore we believe this is the first case report of an antenatal diagnosis of combined pure esophageal and duodenal atresia in a twin gestation. CASE PRESENTATION: We present a case of a 30-year-old G1P0 white woman at 22-week gestation with a monochorionic-diamniotic twin pregnancy discordant for esophageal atresia, duodenal atresia with gastric perforation, hypoplastic left heart structures, and significant early gestation maternal polyhydramnios. In this case, fetal magnetic resonance imaging was able to depict additional findings including area of gastric wall rupture, hiatal hernia, dilation of the distal esophagus, and area of duodenal obstruction and thus facilitated the proper diagnosis. After extensive counseling at our multidisciplinary team meeting, the parents elected to proceed with radiofrequency ablation of the anomalous twin to maximize the survival of the normal co-twin. The procedure was performed successfully with complete cessation of flow in the umbilical artery and complete cardiac standstill in the anomalous twin with no detrimental effects on the healthy co-twin. CONCLUSIONS: Prenatal diagnosis of complex anomalies in twin pregnancies constitutes a multitude of ethical, religious, and cultural factors that come into play in the management of these cases. Fetal magnetic resonance imaging provides detailed valuable information that can assist in management options including possible prenatal intervention. The combination of a cystic structure with peristalsis-like movement above the diaphragm (for example, "the upper thoracic pouch sign"), polyhydramnios, and progressive distention of the stomach and duodenum should increase suspicion for a combined pure esophageal and duodenal atresia.
[Mh] Termos MeSH primário: Obstrução Duodenal/embriologia
Atresia Esofágica/embriologia
Complicações na Gravidez/terapia
Redução de Gravidez Multifetal
Gravidez de Gêmeos
Diagnóstico Pré-Natal
[Mh] Termos MeSH secundário: Adulto
Obstrução Duodenal/diagnóstico por imagem
Atresia Esofágica/diagnóstico por imagem
Feminino
Aconselhamento Genético
Seres Humanos
Recém-Nascido
Poli-Hidrâmnios
Gravidez
Complicações na Gravidez/diagnóstico por imagem
Complicações na Gravidez/psicologia
Resultado da Gravidez
Redução de Gravidez Multifetal/psicologia
Gravidez de Gêmeos/psicologia
Gêmeos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170319
[St] Status:MEDLINE
[do] DOI:10.1186/s13256-016-1195-x


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[PMID]:28272225
[Au] Autor:Li Q; Wu XH; Zhang WS
[Ad] Endereço:Department of Obstetrics and Gynecology, Xiang-Ya Hospital, Central South University, Hunan, Changsha, China.
[Ti] Título:A new method for selective reduction in TRAP sequence with a contraindication to fetoscopic surgery: A case report.
[So] Source:Medicine (Baltimore);96(10):e6250, 2017 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: The preferred method for multifetal pregnancy reduction (MFPR) is a transabdominal intrathoracic or intracranial injection of potassium chloride (KCl). However, in monochorionic multiple pregnancies (MMPs), especially in monoamnionic multifetal pregnancies, selective feticide by this method is often associated with miscarriage of the remaining fetuses. Selective fetal reduction in MMPs by blood flow ablation using radiofrequency ablation or fetoscopic laser surgery may improve survival of the remaining fetus. Although often successful, MFPR by these methods is contraindicated in cases of twin reversed arterial perfusion (TRAP) sequence in triplet pregnancies complicated by polyhydramnios or anterior placenta, as it is difficult to locate the ablation target. PATIENT CONCERNS: 2 cases were admitted to Xiangya Hospital, Central South University with triplet pregnancies at 23 or 21weeks of gestation. DIAGNOSES: Case 1 was a 29-year-old woman with a triplet pregnancy in 2 distinct amniotic sacs and 1 fetus with multiple malformations. Case 2 was a 32-year-old woman who was identified as a triplet pregnancy with TRAP sequence with an acardiac/acephalic twin and anterior placenta. INTERVENTIONS: Both of the 2 cases were underwent a new method for MFPR involving fine needle amniotic fluid aspiration and injection of hypertonic sodium chloride (10% NaCl) into the Wharton jelly of the umbilical cord. OUTCOMES: The 2 cases resulted in selective feticide and the birth of the remaining infants from the triplet pregnancies. All infants were healthy at birth and the 2-year follow-up. LESSONS: The new approach provided a safer, more accessible, and more cost-effective method for MFPR in MMPs with a contraindication to fetoscopic surgery compared to radiofrequency ablation and fetoscopic laser surgery.
[Mh] Termos MeSH primário: Redução de Gravidez Multifetal/métodos
[Mh] Termos MeSH secundário: Adulto
Contraindicações
Feminino
Transfusão Feto-Fetal
Fetoscopia
Seres Humanos
Gravidez
Gravidez Múltipla
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170309
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006250


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[PMID]:27245051
[Au] Autor:Yang R; Liu YY; Zhao L; Wang Y; Li R; Liu P; Ma CH; Chen XN; Qiao J
[Ad] Endereço:Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University Third Hospital, Key Laboratory of Assisted Reproduction, Ministry of Education and Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, China.
[Ti] Título:Human trophoblast cell during first trimester after IVF-ET differs from natural conceived pregnancy in development and function.
[So] Source:Histol Histopathol;32(3):243-251, 2017 Mar.
[Is] ISSN:1699-5848
[Cp] País de publicação:Spain
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To explore the differences of the trophoblast cell function in first trimester between natural pregnancy and pregnancy after IVF-ET therapy. METHODS: 102 cases with twin to singleton fetal reduction after IVF-ET treatment from July 2010 to August 2013 in Peking University Third Hospital were involved in analysis, and eight specimens were obtained from this group. 10 natural-pregnancy cases undergoing artificial abortion with unwanted pregnancy were recruited as control. Semi-quantitative immunohistochemical method was used to detect the expression of EGFR, Bcl-2, tubulin-α, metallothionein and AFP in villi in both groups. RESULTS: Of the 102 cases, 14 cases (13.73%) were aborted. Preterm birth occurred in seven cases (7.86%). Low birth weight occurred in three patients (3.37%), and extremely low birth weight occurred in four cases (4.49%). The expression of EGFR, tubulin-α, Bcl-2, and metallothionein in the IVF-ET group was significantly lower than that in the control group (P<0.05). However, AFP expression was significantly higher in IVF-ET group than in control group (P<0.05). In IVF-ET group, the miscarriage case had weaker EGFR, tubulin-α, and metallothionein expression than full-term pregnancy; the early preterm labor case had weaker Bcl-2, tubulin-α, and metallothionein expression; and velamentous cord insertion case had weaker tubulin-α expression. CONCLUSIONS: The trophoblast cell function of IVF-ET group in first trimester is different from control group in proliferation, invasion, apoptosis and vascular development, and optimal pregnancy outcome depends on the self-healing balance of trophoblast cells.
[Mh] Termos MeSH primário: Fertilização In Vitro/efeitos adversos
Resultado da Gravidez
Trofoblastos/patologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Imuno-Histoquímica
Gravidez
Redução de Gravidez Multifetal
Primeiro Trimestre da Gravidez
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170420
[Lr] Data última revisão:
170420
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160602
[St] Status:MEDLINE
[do] DOI:10.14670/HH-11-787


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[PMID]:27219098
[Au] Autor:Drugan A; Weissman A
[Ti] Título:Multi-fetal pregnancy reduction (MFPR) to twins or singleton - medical justification and ethical slippery slope.
[So] Source:J Perinat Med;45(2):181-184, 2017 Feb 01.
[Is] ISSN:1619-3997
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Multi-fetal pregnancy reduction (MFPR) is an ethically acceptable procedure aimed to increase survival and well-being of the remaining fetuses from high-order multiple gestations. In most cases we offer the procedure to triplets or quadruplets and opt to preserve twins; lately, the option to maintain a single fetus was suggested. We examined the outcomes of 140 pregnancies that underwent MFPR in our center and were followed to delivery - 105 were reduced to twins and 35 to singletons. The rate of procedure-related pregnancy loss was identical (2.9%). Leaving only one fetus was associated with a higher gestational age at delivery (35.4±2.4 weeks vs. 37.7±2.1 weeks, P<0.0001), with heavier neonates (2222 g vs. 3017 g, P<0.0001) and with a reduction in the cesarean section (CS) rate (76% in twins vs. 51.4% in singletons, P=0.02). Six pregnancies reduced to twins (5.8%) ended before 32 weeks as compared to one pregnancy reduced to a singleton. We conclude that reduction of triplets to singletons is medically and ethically acceptable, after thorough counseling of patients. However, considering the pregnancy loss risk of MFPR and the relatively good outcome of twin gestations, reduction of twins to singletons is ethically acceptable only in extraordinary maternal or fetal conditions.
[Mh] Termos MeSH primário: Redução de Gravidez Multifetal/ética
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Gravidez
Resultado da Gravidez/epidemiologia
Redução de Gravidez Multifetal/estatística & dados numéricos
Gravidez de Trigêmeos
Gravidez de Gêmeos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160525
[St] Status:MEDLINE


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[PMID]:27697216
[Au] Autor:Isaac SM; Qu D; Adamson SL
[Ad] Endereço:Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
[Ti] Título:Effect of selective fetectomy on morphology of the mouse placenta.
[So] Source:Placenta;46:11-17, 2016 Oct.
[Is] ISSN:1532-3102
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Placental examination is recommended when genetic mutations cause fetal lethality in mice. But how fetal death alters histomorphology of the surviving mouse placenta is not known. METHODS: Placentas were examined at E17.5 after fetectomy of 1-2 fetal mice per pregnancy at either embryonic day (E) 15.5 (N = 8; Fx-2 group) or E13.5 (N = 5; Fx-4 group), which left 12 ± 2 surviving fetuses per litter. RESULTS: Fetectomy caused no changes in placental weights and no increases in placental hypoxia (pimonidazole staining). The size and cell morphology of the decidua and junctional zone regions were unchanged and, in the Fx-2 group, these regions became significantly less hypoxic. Significant changes in labyrinth volume included a 30% increase in the Fx-2 group and in both groups, a >50% decrease in % fetal blood space and >40% increase in % labyrinth tissue. Maternal blood sinusoid volume was unchanged. Cell death in the labyrinth was significantly increased (22-fold increase in TUNEL staining) whereas placental mRNA expression of the proliferation marker Mki67 was unchanged. mRNA expression of sFlt1 and Prl3b1 (mPL-II) was unchanged in the labyrinth and junctional zone tissues in the Fx-2 group and in whole placental tissue in the Fx-4 group. DISCUSSION: Placental examination of the junctional zone and decidual regions after spontaneous fetal death in late gestation is likely to yield useful phenotypic information and abnormalities that may contribute to fetal death. In contrast, labyrinth abnormalities including increased tissue volume and reduced fetoplacental vascularity may not be due to genetic perturbation nor predate fetal death.
[Mh] Termos MeSH primário: Placenta/anatomia & histologia
Redução de Gravidez Multifetal
[Mh] Termos MeSH secundário: Animais
Feminino
Camundongos
Placenta/fisiologia
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161005
[St] Status:MEDLINE


  10 / 713 MEDLINE  
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[PMID]:27593480
[Au] Autor:Haas J; Barzilay E; Hourvitz A; Dor J; Lipitz S; Yinon Y; Shlomi M; Shulman A
[Ad] Endereço:IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel. Electronic address: jigalh@hotmail.com.
[Ti] Título:Outcome of early versus late multifetal pregnancy reduction.
[So] Source:Reprod Biomed Online;33(5):629-634, 2016 Nov.
[Is] ISSN:1472-6491
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Multifetal pregnancy reduction (MPR) is an accepted method of reducing complications of triplet pregnancies and higher-order multifetal pregnancies. Eighty-three pregnancies that underwent early (68 weeks) transvaginal MPR were compared with 125 pregnancies that underwent late (11-14 weeks) transabdominal MPR. Rates of pregnancy loss, preterm delivery, gestational diabetes and hypertensive disorders were similar among both groups. Early MPR was associated with a lower risk for small for gestational age newborns (6.5% versus 19.2%; P = 0.034; OR 0.32; 95% CI 0.11 to 0.92) and a higher risk for single-fetus loss (6% versus 0.8%; P = 0.041; OR 10.58; 95% CI 1.1 to 101.94). Preterm delivery rates seemed to be similar between the two groups. In MPR from triplets, an apparent benefit was observed for early MPR in preterm deliveries before 37 weeks, whereas, in MPR from high-order pregnancies, a benefit was observed for late MPR in deliveries before 32 weeks. Perinatal outcomes of twin pregnancies after early and late MPR seem to be grossly similar. Optimal timing for multifetal reduction depends on other factors, namely, the selectivity of the procedure and patient's preference.
[Mh] Termos MeSH primário: Resultado da Gravidez
Redução de Gravidez Multifetal/métodos
[Mh] Termos MeSH secundário: Aborto Espontâneo
Feminino
Idade Gestacional
Seres Humanos
Gravidez
Redução de Gravidez Multifetal/efeitos adversos
Gravidez de Gêmeos
Nascimento Prematuro/epidemiologia
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160906
[St] Status:MEDLINE



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