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

Abstract

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

Abstract

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

Abstract

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

Serial Cervical Length Evaluation in Low-Risk Women with Shortened Cervical Lengths in the Midtrimester: How Many Will Dilate Prior to 24 Weeks?

For women diagnosed with a short cervix, there is controversy regarding the proper management and follow-up. In this study, we demonstrate that a significant proportion of women with a short cervix in the second trimester will ultimately have a dilated cervix, which is a more concerning situation and often requires different management. These results indicate that one should continue surveillance after the diagnosis of a short cervix.

Induction of Labor versus Cesarean Delivery in Twin Pregnancies

Abstract

For women with twin pregnancies, we have previously shown that outcomes are similar for attempted vaginal delivery as compared to cesarean delivery.  In this study, we demonstrate that this remains true even for women with twin pregnancies who require induction of labor.

Listen to More On Healthful Woman

“Delivery of Twins – Double the Fun!” – with Dr. Stephanie Melka

Subchorionic Hematomas and Adverse Pregnancy Outcomes among Twin Pregnancies

Abstract

Subchorionic hematomas, or subchorionic hemorrhages, are common ultrasound findings in early pregnancy.   However, their significance is uncertain.  Some believe they increase the risk of many pregnancy complications, including pregnancy loss / miscarriage.  In prior studies we demonstrated that subchorionic hematoma does not appear to increase the risk adverse outcomes in singleton pregnancies.

In this study, we present similar results regarding twin pregnancies – subchorionic hematoma does not appear to increase the risk of adverse outcomes in twin pregnancies.

Prior Studies

Association Between First-Trimester Subchorionic Hematomas and Adverse Pregnancy Outcomes After 20 Weeks of Gestation in Singleton Pregnancies

Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies

Association Between First-Trimester Subchorionic Hematomas and Adverse Pregnancy Outcomes After 20 Weeks of Gestation in Singleton Pregnancies

Subchorionic hematomas, or subchorionic hemorrhages, are common ultrasound findings in early pregnancy. However, their significance is uncertain. Some believe they increase the risk of many pregnancy complications, including pregnancy loss / miscarriage. In a prior study we demonstrated that subchorionic hematoma does not appear to increase the risk of miscarriage in singleton pregnancies.

In this study, we present similar results regarding other adverse pregnancy outcomes – subchorionic hematoma does not appear to increase the risk of adverse outcomes later in pregnancy.