National and international guidelines on the management of twin pregnancies: a comparative review

This study reviews clinical practice guidelines from 11 professional societies in 7 high-income countries and 2 international societies regarding the management of twin pregnancies. The analysis reveals inconsistencies and disagreements, particularly in areas such as screening for preterm birth, aspirin use for preventing preeclampsia, defining fetal growth restriction, and timing of delivery. The study aims to help healthcare providers access and compare recommendations while highlighting areas for future research due to ongoing disagreements or limited evidence.

Vasa Previa: When Labor Is Not an Option

Recent improvements in ultrasound assessment and umbilical cord visualization have allowed obstetricians to more precisely identify a rare but potentially devastating birthing complication called vasa previa. This condition occurs when unprotected fetal blood vessels run through the amniotic membranes and pass through the cervix. This can result in many complications, including fetal death. Taking this information into account, Maternal-Fetal Medicine Center physicians are now scheduling cesarean deliveries during the late pre-term period to improve outcomes for both mothers and babies.

Incidence and Risk Factors for a Malpositioned Intrauterine Device Detected on Three-Dimensional Ultrasound Within Eight Weeks of Placement

The objective of this publication is to estimate the incidence of intrauterine device (IUD) malpositioning detected on three-dimensional (3D) transvaginal ultrasound within 8 weeks of placement and identify risk factors for malpositioning. A total of 1011 unique IUD placements were identified at our practice during the study period.

ACGME Milestones in global health: Need for standardized assessment of global health training in obstetrics/gynecology residency

In total, 259 publications resulted from the preliminary search. Five articles described US global health residency training in Ob/Gyn in some capacity. Only one publication described a specific global health elective and its evaluation with respect to ACGME Milestones. Despite growing popularity of global health electives among residency programs, few are assessing the educational value of these offerings using ACGME Milestones or describing these efforts in the literature.

Maternal Morbidity with Repeated Cesarean Deliveries

For women with prior cesarean deliveries, one question we often get is: “how many can I have?”. Traditionally, doctors have told women it was unsafe to have more than 3 or 4 cesareans. in this study, we looked at complication rates from multiple cesareans in our own practice. We found that while the rate of complications does increase with the number of cesareans, the overall risks are low, and likely lower than many people assume.

Elective fetal reduction by radiofrequency ablation in monochorionic diamniotic twins decreases adverse outcomes compared to ongoing monochorionic diamniotic twins

Multifetal pregnancy reduction is a technique used to reduce the fetal number to mitigate the risks of adverse outcomes associated with multiple gestations. Monochorionic diamniotic twin pregnancies are subject to unique complications, contributing to adverse pregnancy outcomes. Thus, patients have an option to electively reduce 1 fetus to improve outcomes.

Non-invasive prenatal testing in the management of twin pregnancies


Twin pregnancies are common and associated with pregnancy complications and adverse outcomes. Prenatal clinical management is intensive and has been hampered by inferior screening and less acceptable invasive testing. For aneuploidy screening, meta‐analyses show that non‐invasive prenatal testing (NIPT) through analysis of cell‐free DNA (cf‐DNA) is superior to serum and ultrasound‐based tests. The positive predictive value for NIPT is driven strongly by the discriminatory power of the assay and only secondarily by the prior risk. Uncertainties in a priori risks for aneuploidies in twin pregnancies are therefore of lesser importance with NIPT. Additional information on zygosity can be obtained using NIPT. Establishing zygosity can be helpful when chorionicity was not reliably established early in pregnancy or where the there is a concern for one versus two affected fetuses. In dizygotic twin pregnancies, individual fetal fractions can be measured to ensure that both values are satisfactory. Vanishing twins can be identified by NIPT. Although clinical utility of routinely detecting vanishing twins has not yet been demonstrated, there are individual cases where cf‐DNA analysis could be helpful in explaining unusual clinical or laboratory observations. We conclude that cf‐DNA analysis and ultrasound have synergistic roles in the management of multiple gestational pregnancies.

The Advice We Give to Pregnant Women


Pregnant women are often advised to sleep on their left side. However, this recommendation lacks supporting evidence, and can be very difficult for pregnant women to do. In this editorial, Dr. Fox and noted author of “Expecting Better”, Professor Emily Oster, discuss a recent article about sleep position in pregnancy goes against this recommendation, as well as their own opinions on this topic.

Listen to Emily Oster on the Podcast

“Pregnancy in the Land of Corona!” -with Emily Oster

“Ending the Quarantine: If, When, and How?” – with Emily Oster

The Association Between Shirodkar Cerclage and Preterm Premature Rupture of Membranes in Singleton Pregnancies

Certain women with high-risk pregnancies undergo a cerclage placement, which is a surgical procedure intended to keep the cervix closed, prolong pregnancy, and prevent pregnancy loss or preterm birth. One of the classis risks of cerclage is the risk of membrane rupture (the “water breaking”) while the cerclage is in place. In this study, we found that the risk of this happening is only approximately 10%, and appears to be mostly due to the risk factors for preterm birth, and not actually the cerclage itself.

The Effect of Microbiome Exposure at Birth on Pediatric Outcomes Using a Twin Cohort Discordant for Microbiome Exposure at Birth


The microbiome refers to the normal bacteria that live on our skin and in our bodies. There has been much written about the effect of differing microbiome exposures at birth and outcomes later in childhood and adulthood. In this study, we examined twins with differing microbiome exposure and found no differences at ages 2-10 years old, suggesting the importance of this variable may be overstated.

Listen to More on Healthful Woman

“The Microbiome” – with Dr. Shari Gelber