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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This review of the medical and ethical indications and techniques of embryo reduction in multiple pregnancy induced by ovulation induction, in vitro fertilization, or embryo transfer, discusses incidence, consequences, and prevention of high-order multiple pregnancies. Also presented were an analysis of results of 922 pregnancies and a French multicentre study of 262 embryo reduction procedures where an embryo quality score was employed. The incidence of multiple pregnancies in ovarian stimulation ranges from 11 to 44%. In the authors' series of 922 pregnancies followed between May 1982 and May 1990 there were 20% twins and 3% triplets. Triplets were more common after cocyte donation and embryo transfer. Embryo reductions can be done transcervically, transabdominally, or transuterine under endovaginal echo control, which is the safest method. All selective embryo reductions reduce somewhat the risk of premature threatened labor, prematurity and perinatal mortality that would result in higher order multiple pregnancies. A retrospective study of 372 singleton, 102 twin, and 13 triplet pregnancies suggested that the only way to prevent multiple pregnancies is to control the dose of hCG used and the number of embryos transferred. Another approach is to use an embryo quality score based on anatomic uniformity of the embryos transferred. The optimum is to transfer 2 embryos with a total score of 16 or 3 with a score of 16-22. For ovarian stimulation, the number of follicles 10 mm or the estradiol level can be followed. A survey of embryo reduction procedures done in France found that most were done after ovulation induction and for 3, 4, or more fetuses. Other controversial indications for reduction procedures are chromosomal abnormalities and fetal malformations.
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PMID:Is there an indication for embryo reduction? 144 69

This study compares the maternal, obstetrical, labour and pregnancy outcome characteristics of 2,412 breech-presenting births with 17,946 vertex-presenting births. Mothers of babies presenting as breeches were significantly more likely to have had a previous miscarriage, an obstetric complication, a threatened miscarriage or threatened labour during the current pregnancy, or Caesarean section than mothers of babies with vertex presentation. The babies presenting as breeches had significantly more neonatal morbidity and perinatal mortality. They showed higher rates of suspected intrauterine growth retardation, prematurity, low birth-weight, low Apgar scores and congenital anomalies. The overall perinatal mortality for breech presentations was almost 9 times higher than for vertex presentations. Unconditional multiple logistic regression analysis showed that, even after adjusting for low birth-weight and the presence of congenital anomalies, breech presentation still showed a statistically significant association with perinatal death. The study alludes to the possibility that breech presentation, in a significant number of cases, may not be coincidental but a marker for some preconceptional or prenatal disturbance. The study also shows an excess of breech presentations in females which is unexplained and may point to a genetic or hormonal susceptibility of the fetus.
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PMID:Breech presentation in South Australia, 1987-1989. 849 32