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Titolo:
Improvement in outcomes of multifetal pregnancy reduction with increased experience
Autore:
Evans, MI; Berkowitz, RL; Wapner, RJ; Carpenter, RJ; Goldberg, JD; Ayoub, MA; Horenstein, J; Dommergues, M; Brambati, B; Nicolaides, KH; Holzgreve, W; Timor-Tritsch, IE;
Indirizzi:
MCPHU, Dept Obstet & Gynecol, Philadelphia, PA 19102 USA MCPHU Philadelphia PA USA 19102 tet & Gynecol, Philadelphia, PA 19102 USA Wayne State Univ, Dept Obstet & Gynecol, Detroit, MI 48202 USA Wayne StateUniv Detroit MI USA 48202 et & Gynecol, Detroit, MI 48202 USA Wayne State Univ, Dept Obstet & Gynecol, Detroit, MI 48202 USA Wayne StateUniv Detroit MI USA 48202 et & Gynecol, Detroit, MI 48202 USA Mt Sinai Med Ctr, Dept Obstet & Gynecol, New York, NY USA Mt Sinai Med Ctr New York NY USA Dept Obstet & Gynecol, New York, NY USA NYU, Dept Obstet & Gynecol, New York, NY 10016 USA NYU New York NY USA 10016 , Dept Obstet & Gynecol, New York, NY 10016 USA Thomas Jefferson Univ, Philadelphia, PA 19107 USA Thomas Jefferson Univ Philadelphia PA USA 19107 hiladelphia, PA 19107 USA St Lukes Episcopal Hosp, Houston, TX 77030 USA St Lukes Episcopal Hosp Houston TX USA 77030 Hosp, Houston, TX 77030 USA Calif Pacific Med Ctr, San Francisco, CA USA Calif Pacific Med Ctr San Francisco CA USA ed Ctr, San Francisco, CA USA Calif Hosp Med Ctr, Los Angeles, CA USA Calif Hosp Med Ctr Los Angeles CAUSA Hosp Med Ctr, Los Angeles, CA USA Nekker Hosp, Paris, France Nekker Hosp Paris FranceNekker Hosp, Paris, France Univ Milan, Milan, Italy Univ Milan Milan ItalyUniv Milan, Milan, Italy Univ London Kings Coll, London WC2R 2LS, England Univ London Kings Coll London England WC2R 2LS London WC2R 2LS, England Univ Basel, Basel, Switzerland Univ Basel Basel SwitzerlandUniv Basel, Basel, Switzerland
Titolo Testata:
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
fascicolo: 2, volume: 184, anno: 2001,
pagine: 97 - 103
SICI:
0002-9378(200101)184:2<97:IIOOMP>2.0.ZU;2-U
Fonte:
ISI
Lingua:
ENG
Soggetto:
COLLABORATIVE EXPERIENCE; SELECTIVE TERMINATION; RISK; TWINS;
Keywords:
fetal growth; infertility therapies; multifetal pregnancies; multifetal pregnancy reduction; prematurity;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
17
Recensione:
Indirizzi per estratti:
Indirizzo: Evans, MI MCPHU, Dept Obstet & Gynecol, 245 N 15th St,MS495, Philadelphia,PA 19102 USA MCPHU 245 N 15th St,MS495 Philadelphia PA USA 19102 PA 19102 USA
Citazione:
M.I. Evans et al., "Improvement in outcomes of multifetal pregnancy reduction with increased experience", AM J OBST G, 184(2), 2001, pp. 97-103

Abstract

OBJECTIVE: This study was undertaken to evaluate a decade of data on multifetal pregnancy reductions at centers with extensive experiences. STUDY DESIGN: A total of 3513 completed cases from 11 centers in 5 countries were analyzed according to year (before 1990, 1991-1994, and 1995-1998),starting and finishing numbers of embryos or fetuses, and outcomes. RESULTS: With increasing experience there has been a considerable improvement in outcomes, with decreases in rates of both pregnancy loss and prematurity. Overall loss rates in the last few years were correlated strongly with starting and finishing numbers (starting number greater than or equal to6, 15.4%; starting number 5, 11.4%; starting number 4, 7.3%; starting number3, 4.5%; starting number 2, 6.2%: finishing number 3, 18.4%; finishing number 2, 6.0%; finishing number 1, 6.7%). Birth weight discordance between surviving twins was increased with greater starting number. The proportion ofcases with starting number greater than or equal to5 diminished from 23.4%to 15.9% to 12.2%. The proportion of patients >40 years old increased in the last 6 years to 9.3%. Gestational age at delivery did not vary with increasing maternal age but was inversely correlated with starting number. CONCLUSION: Multifetal pregnancy reduction outcomes at our centers for both losses and early prematurity have improved considerably with experience. Reductions from triplets to twins and now from quadruplets to twins carry outcomes as good as those of unreduced twin gestations. Patient demographic characteristics continues to change as more older women use assisted reproductive technologies. In terms of losses, prematurity, and growth, higher starting numbers carry worse outcomes.

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Documento generato il 21/09/20 alle ore 09:46:02