OBJECTIVETo analyse the effect of the reduction of multiple pregnancy through transvaginal ultrasonic monitoring on the pregnancy outcome.

METHODSEighty-four cases were divided into two groups according to whether they had vaginal hemorrhage before operation. And the pregnancy outcomes were analyzed.

RESULTSThe abortion rate and preterm birth rate of the vaginal hemorrhage group were higher, and the difference was statistically significant.

CONCLUSIONSThe reduction of multiple pregnancy through transvaginal ultrasonic monitoring is a safe operative method. But it is only a remedial treatment for multiple pregnancy, and how to prevent multiple pregnancy is of more practical value.

Adult ; Female ; Humans ; Pregnancy ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal ; statistics & numerical data ; Pregnancy, Multiple ; statistics & numerical data ; Ultrasonography, Prenatal

BACKGROUND: The purpose of this study was to compare the fetal/infant mortality risk associated with each additional week of expectant management to that associated with immediate delivery in women with multiple gestations. METHODS: This was a retrospective national cohort study of 94,170 multiple deliveries, 92,619 (98.4%) twin and 1,352 (1.44%) triplet pregnancies, between 32 0/7 and 42 6/7 weeks of gestation recorded in the Korean vital statistics database. We investigated the risks of stillbirth and infant death after birth in Korea according to the week of gestation in twin and triplet pregnancies. RESULTS: The risk of stillbirth significantly increased between 34 and 35 weeks of gestation and between 37 and 38 weeks of gestation in twin pregnancies and between 34 and 37 weeks of gestation in triplet pregnancies. The risk of infant death following delivery gradually decreased as pregnancies approached full term. Week-by-week differences were statistically significant between 33 and 34 weeks, with decreasing risks of infant death at advancing gestational ages in twin pregnancies. At 37 weeks of gestation, the relative risk of mortality was significantly higher with expectant management compared with immediate delivery (relative risk, 3.00; 95% confidence interval, 1.41–6.38). CONCLUSION: In twin pregnancies, delivery at 37 weeks of gestation can minimize the risks of stillbirth and infant death in uncomplicated cases, although individual maternal and fetal characteristics must be considered when determining the optimal timing of delivery. In multiple pregnancies, close fetal surveillance is needed after 34 weeks of gestation.
Cohort Studies* ; Delivery, Obstetric ; Female ; Gestational Age ; Humans ; Infant Death* ; Infant* ; Korea ; Mortality ; Parturition ; Pregnancy ; Pregnancy, Multiple* ; Pregnancy, Triplet ; Pregnancy, Twin ; Retrospective Studies ; Stillbirth* ; Twins ; Vital Statistics

INTRODUCTION: This study investigated the differences in clinical pregnancy rate (CPR), live birth rate (LBR) and multiple pregnancy rate (MPR) between double cleavage-stage embryo transfers compared to single and double blastocysts stage embryo transfers in a single academic medical centre. MATERIALS AND METHODS: This was a retrospective cohort study performed at the KK Women's and Children's Hospital In Vitro Fertilisation (KKIVF) Centre of all women who underwent fresh-cycle in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) cycles over a 5-year period. The outcome measures were CPR, LBR and MPR. The study included 5294 cycles, of which 539 patients underwent single embryo transfer (SET); 4533 patients underwent double embryo transfer (DET); 84 patients underwent double blastocyst embryo transfer (DBT); and 65 patients underwent single blastocyst embryo transfer (SBT). RESULTS: The mean age of patients undergoing single blastocysts stage embryo transfer was lower than the other 2 groups. The DET, single and double blastocysts stage embryo transfer groups achieved similar LBR (33.9%, 38.7%, 35.4%, >0.05) and CPR (42.4%, 46.2%, 46.9%). CONCLUSION We found that single blastocysts stage embryo transfer is associated with similar LBR and CPR compared to double blastocysts stage embryo transfer and DET, with lower MPRs, and should be offered as standard practice, where possible.
Adult ; Cohort Studies ; Cryopreservation ; methods ; statistics & numerical data ; Embryo Transfer ; adverse effects ; methods ; statistics & numerical data ; Female ; Fertilization in Vitro ; statistics & numerical data ; Humans ; Live Birth ; epidemiology ; Pregnancy ; Pregnancy Outcome ; epidemiology ; Pregnancy Rate ; Pregnancy, Multiple ; statistics & numerical data ; Retrospective Studies ; Singapore ; Single Embryo Transfer ; adverse effects ; methods ; statistics & numerical data ; Sperm Injections, Intracytoplasmic ; statistics & numerical data

Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary.
Cesarean Section/*statistics & numerical data/trends ; Data Collection ; Female ; Humans ; *Insurance, Health ; Insurance, Liability ; Maternal Age ; Obesity/epidemiology ; Pregnancy ; Pregnancy, Multiple/statistics & numerical data ; Republic of Korea ; Social Class ; Vaginal Birth after Cesarean/*statistics & numerical data/trends

The aim of this study was to survey multiple birth data and to analyze the recent trends of multiple births and its consequences on perinatal problems in Korea from 1991 to 2008. Data were obtained from the Korean Statistical Information Service. The total number of multiple births showed increasing trends. The multiple birth rate was maintained within less than 10.0 for the decade from 1981 to 1990. However, it increased gradually to reach 27.5 in 2008. The maternal age for multiple births was higher than for total live births. The mean birth weight of the total live births was 3.23 kg; for the multiple births it was 2.40 kg in 2008. The incidence of low birth weight infants (LBWI) among total live births was 3.8% in 2000 and 4.9% in 2008. For multiple births it was 49.2% and 53.0% during the same years. The incidence of preterm births among total live births was 3.8% in 2000 and 5.5% in 2008; for the multiple births it was 38.3% and 51.5% during the same years. The incidence of multiple births and its consequences on perinatal problems (preterm, LBWI, and advanced-maternal age) have been increased steadily over the last two decades in Korea.
Birth Rate/*trends ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Maternal Age ; Multiple Birth Offspring/*statistics & numerical data ; *Perinatal Care ; Pregnancy ; Pregnancy, Multiple ; Premature Birth ; Republic of Korea

OBJECTIVETo review the health status of mothers undergoing in vitro fertilization-embryo transfer (IVF) and their offspring.

METHODSHealth status of 210 IVF mothers and offspring performed from January 1, 2001 through December 31, 2002 was compared with that of those who conceived naturally retrospectively.

RESULTA significant differences were found in rates of multiple births, hypertensive disorders in pregnancy,cesarean section, preterm delivery,low (and very low) birth weight infant,malformation(33.33 % with compared 1.72 %, 10.87 % with compared 4.59 %, 89.85 % with compared 65.57 %, 24.64 % with compared 6.27 %, 25.68 % with compared 8.23 %, 3.83 % with compared 1.17 %, all P<0.01) between IVF and those conceived naturally. The rates of hypertensive disorders in pregnancy,preterm delivery, low (and very low) birth weight infant were related to the rate of multiple births OR. 95 %CI were 3.49, 1.16-10.50; 13.65, 5.39-34.58; 14.91, 5.53-40.17; respectively. There was no statistical difference in neonatal outcome between normal IVF and intra-cytop-lasmic sperm injection (P>0.05); no difference in height and weight between full-term and preterm (P>0.05).

CONCLUSIONAssisted reproductive technologies increase multiple births rate, resulting in high rates of hypertensive disorders, preterm delivery, low (and very low) birth weight infant.

Adult ; Cesarean Section ; statistics & numerical data ; China ; epidemiology ; Embryo Transfer ; Female ; Fertilization in Vitro ; Health Status ; Humans ; Hypertension, Pregnancy-Induced ; epidemiology ; Multiple Birth Offspring ; Pregnancy ; Premature Birth ; epidemiology ; Retrospective Studies

Clinical and statistical observations were performed on 1,930 cases of pregnant women who were admitted for delivery in the Department of Obstetrics, Kyung Hee University Hospital during 1 year (1982) and on 1,961 cases of neonates who were born to the former. The results were obtained as follows: 1. Concerning maternal age distribution, the commonest age group was that of 25~29 and the proportion of the age group 20-29 was 82.4% of all. 2 Concerning obstetrical history, the proportion of the women who had no prior experience of delivery nor abortion was the highest, 45.5%. 3. Concerning abortion history, 36.1% of the women had experienced it and the mean number was 1.8. 4. Type of delivery was as follows: Spontaneous delivery; 58.1%, Vacuum extracted delivery; 22.4%, Cesarean section; 18.8%, Breech delivery; 0.7%. 5. Gestational period distribution of the neonates was as follows: Under 37 weeks (Preterm); 7.1%, Between 38 and 42 weeks (Terms); 87.2%, More than 43 weeks (Postterm); 5.7%. 6. Sex ratio of male to female of the neonates was 1.03 : 1. 7. Birth weight distribution was as follows: Under 2,500gm.; 9.0%, Between 2,501 and 4,000gm.; 85.5%, More than 4,001gm.; 5.5%. 8. The measured growth data of neonates were as follows: Body weight; 3.28kg. for male, 3.18kg. for female, Body height; 50.40cm for male, 49.77cm for female, Chest circumference; 32.54cm for male, 32.17cm for female, Head circumference; 33.49cm for male, 33.11cm for female. 9. The mean values of Apgar score per 1 minute were 7.70 for male and 7.63 for female. 10. The incidence rate of neonatal jaundice was 50.0% and no difference in sex respectively, but more prevalent in preterm baby. 11. The incidence rate of neonatal diseases was 8.9% and the commonest disease was neonatal infection (35.6%). 12. Concerning multiple pregnancy, ratio to single births was 1 : 64.3 and the sex ratio of male to female was 1 : 1.03. 13. The incidence rate of congenital anomaly was 2.4% and the commonest anomaly was digestive system anomaly (30.9%). 14. The neonatal mortality rate was 11.73 per 1,000 neonates, and the majority of neonatal deaths were in low birth weight and preterm neonates (78.3%). 15. The causes of neonatal deaths in decreasing order of frequency were abnormal ventilation (39.1%), prematurity (30.4%), congenital anomaly (13.0%) and etc.
Abortion, Induced ; Apgar Score ; Birth Weight ; Body Height ; Body Weight ; Cesarean Section ; Digestive System ; Female ; Head ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Low Birth Weight ; Infant, Newborn* ; Jaundice, Neonatal ; Male ; Maternal Age ; Obstetrics ; Parturition ; Pregnancy* ; Pregnancy, Multiple ; Pregnant Women* ; Sex Ratio ; Statistics as Topic* ; Thorax ; Vacuum ; Ventilation

PURPOSE: Congenital anomalies are known as a major cause of neonatal death with prematurity and birth injuries. We surveyed the incidence of congenital anomalies among livebirths and stillbirths delivered at our hospital, and detected in neonatal and postneonatal period. METHODS: The statistical study was done about congenital anomalies among 9,569 deliveries (9,438 livebirths and 131 stillbirths) at Ulsan University Hospital during the periods of 5 years from Jan 1992 to Dec 1996. We reviewed delivery and newborn record, OPD chart, admission chart retrospectively. We investigated the incidence of congenital anomaly according to each year, period, outcome of delivery, sex, birth weight, gestational age, maternal age, Apgar score, multiple pregnancy, and each system. RESULTS: 1) The overall incidence of congenital anomalies was 5.0% (481 cases) among 9,569 deliveries. The annual incidence was 4.5% in 1992, 5.1% in 1993, 5.2% in 1994, 5.8% in 1995, 4.7% in 1996. 2) The incidence of congenital anomalies detected in neonatal period was 3.5% (333 cases) and 1.5% (148 cases) in postneonatal periods. 3) The incidence of congenital anomalies was 4.9% among live births and 9.2% among stillbirths. 4) The incidence of congenital anomalies was 5.3% in male and 4.7% in female. 5) The incidence of congenital anomalies among the babies, below 2,500g of birth weight was 7.7%, between 2,500g and 3,999g was 4.7%, and over 4,000g was 6.8N. 6) The incidence of congenital anomalies among the babies, below 32 weeks of gestational age was 12.9%, between 32 weeks and 36 weeks was 7.4%, between 37 weeks and 41 weeks was 4.7%, and over 42 weeks was 5.1%. 7) The babies born to mothers younger than 20 years of age have anomalies in 7.1%, mother between 20 years of age and 35 years of age in 5.0%, and older than 35 years of age in 6.5%. 8) The incidence of congenital anomalies according to Apgar score among live births between 0 and 3 was 9.8%, between 4 and 6 was 6.0%, and between 7 and 10 was 5.0%. 9) The incidence of congenital anomalies according to multiple pregnancy was 8.6%. 10)The systems of congenital anomalies in order of incidence were as follows; The digestive system (25.6%), the cardiovascular system (22.1%), the genitourinary system (18.9%), the musculoskeletal system (15.5%), the skin and soft tissue (11.7%), the central nervous system (1.6%), the respiratory system (l%), the others (3.6%). CONCLUSIONS: Regular examination and screening on congenital anomaly is required from newborn period to infant and childhood. In view of these considerations, the incidence of congenital anomaly may be increased more than the past reports because of development of recent diagnostic techniques.
Apgar Score ; Birth Injuries ; Birth Weight ; Cardiovascular System ; Central Nervous System ; Digestive System ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Live Birth ; Male ; Mass Screening ; Maternal Age ; Mothers ; Musculoskeletal System ; Pregnancy ; Pregnancy, Multiple ; Respiratory System ; Retrospective Studies ; Skin ; Statistics as Topic* ; Stillbirth ; Ulsan ; Urogenital System