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  1. Article ; Online: Characteristics associated with trial of labor among patients with twin pregnancies.

    Cipres, Danielle T / Cowherd, Rachael / Barry, Olivia H / Chen, Liqi / Yee, Lynn M

    American journal of perinatology

    2024  

    Abstract: Objective: This study aimed to identify patient and provider factors associated with undergoing trial of labor among eligible patients with twin gestations.: Study design: This retrospective cohort study of patients with twin gestations who received ... ...

    Abstract Objective: This study aimed to identify patient and provider factors associated with undergoing trial of labor among eligible patients with twin gestations.
    Study design: This retrospective cohort study of patients with twin gestations who received care at a large tertiary care center from 2000-2016 included individuals with live pregnancies greater than twenty-three weeks of gestation and cephalic-presenting twin. Patients with a prior uterine scar or contraindication to vaginal delivery were excluded from analyses. Maternal and clinical characteristics were compared among patients who did and did not undergo trial of labor. Multivariable logistic regression models included characteristics chosen a priori and those with bivariable associations with p <0.1. Interactions between parity and other significant variables in the primary models were also investigated.
    Results: Among 1888 eligible patients, 80.7% (N=1524) underwent trial of labor. Those undergoing trial of labor were more likely to be younger, multiparous, and have a maternal-fetal medicine physician as the delivering provider (p<0.01). Hypertensive disorders of pregnancy were less prevalent among patients undergoing trial of labor (20.2% vs. 27.8%, p<0.01). In multivariable analysis, advanced maternal age (aOR 0.55, 95% CI 0.40-0.74) and nulliparity (aOR 0.36, 95% CI 0.25-0.52) conferred a lower odds of trial of labor, while having a maternal-fetal medicine provider (aOR 2.74, 95% CI 1.55-4.83) was associated with higher odds. Interaction analyses demonstrated no significant interaction effects between parity and other characteristics. Among those undergoing trial of labor, 76.0% (1158/1524) had a successful vaginal delivery of both twins, with 48.1% (557/1158) having breech extraction of the second twin.
    Conclusion: In this cohort of twin gestations with a high frequency of trial of labor, patient and provider characteristics are associated with attempting vaginal delivery. Variation in provider practices suggests differing skills and comfort with twin vaginal delivery may influence route of delivery decision-making in patients with twins.
    Language English
    Publishing date 2024-03-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/a-2295-3329
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1929: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article: Characteristics Associated with Trial of Labor among Patients with Twin Pregnancies

    Cipres, Danielle T. / Cowherd, Rachael B. / Barry, Olivia H. / Chen, Liqi / Yee, Lynn M.

    American Journal of Perinatology

    2024  

    Abstract: Objective: This study aimed to identify patient and provider factors associated with undergoing trial of labor (TOL) among eligible patients with twin gestations.: Study Design: This retrospective cohort study of patients with twin gestations who ... ...

    Abstract Objective: This study aimed to identify patient and provider factors associated with undergoing trial of labor (TOL) among eligible patients with twin gestations.
    Study Design: This retrospective cohort study of patients with twin gestations who received care at a large tertiary care center from 2000 to 2016 included individuals with live pregnancies greater than 23 weeks of gestation and cephalic-presenting twin. Patients with a prior uterine scar or contraindication to vaginal delivery were excluded from analyses. Maternal and clinical characteristics were compared among patients who did and did not undergo TOL. Multivariable logistic regression models included characteristics chosen a priori and those with bivariable associations with p  < 0.1. Interactions between parity and other significant variables in the primary models were also investigated.
    Results: Among 1,888 eligible patients, 80.7% ( N  = 1,524) underwent TOL. Those undergoing TOL were more likely to be younger, multiparous, and have a maternal–fetal medicine physician as the delivering provider ( p  < 0.01). Hypertensive disorders of pregnancy were less prevalent among patients undergoing TOL (20.2 vs. 27.8%, p  < 0.01). In multivariable analysis, advanced maternal age (adjusted odds ratio [aOR]: 0.55, 95% confidence interval [CI]: 0.40–0.74) and nulliparity (aOR: 0.36, 95% CI: 0.25–0.52) conferred a lower odds of TOL, while having a maternal–fetal medicine provider (aOR: 2.74, 95% CI: 1.55–4.83) was associated with higher odds. Interaction analyses demonstrated no significant interaction effects between parity and other characteristics. Among those undergoing a TOL, 76.0% (1,158/1,524) had a successful vaginal delivery of both twins, with 48.1% (557/1,158) having breech extraction of the second twin.
    Conclusion: In this cohort of twin gestations with a high frequency of TOL, patient and provider characteristics are associated with attempting vaginal delivery. Variation in provider practices suggests differing skills and comfort with twin vaginal delivery may influence route of delivery decision-making in patients with twins.
    Keypoints: Most patients with twin pregnancies undergoing TOL had successful vaginal deliveries. Having an MFM delivering provider was associated with higher odds of attempting twin TOL. Nulliparity and advanced maternal age were associated with lower odds of twin TOL.
    Keywords breech extraction ; delivery route ; maternal–fetal medicine ; trial of labor ; twin pregnancy ; vaginal delivery
    Language English
    Publishing date 2024-03-26
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/a-2295-3329
    Database Thieme publisher's database

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 1929: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  3. Article ; Online: The Association of Twin Chorionicity with Maternal Outcomes.

    Cowherd, Rachael B / Cipres, Danielle T / Chen, Liqi / Barry, Olivia H / Estevez, Samantha L / Yee, Lynn M

    American journal of perinatology

    2022  Volume 41, Issue 5, Page(s) 611–617

    Abstract: Objective:  Our objective was to investigate the association between maternal outcomes and twin chorionicity in a large, contemporary obstetric population.: Study design:  Retrospective cohort study was conducted at a single, large tertiary care ... ...

    Abstract Objective:  Our objective was to investigate the association between maternal outcomes and twin chorionicity in a large, contemporary obstetric population.
    Study design:  Retrospective cohort study was conducted at a single, large tertiary care center. Prenatal and inpatient records for all individuals with twin gestations were reviewed from 2000 to 2016. Patients with monoamniotic twins, higher-order multiples reduced to twins, multiple sets of twins in the study period, or undetermined chorionicity were excluded. Patients with monochorionic twins were compared with those with dichorionic twins. The co-primary outcomes were gestational diabetes mellitus and hypertensive disorders of pregnancy. Secondary outcomes included cesarean delivery, preterm delivery, postpartum hemorrhage, and other maternal outcomes. Bivariate and multivariate analyses were performed to assess associations of chorionicity with maternal outcomes.
    Results:  Of the 2,979 patients eligible for inclusion, 2,627 (88.2%) had dichorionic twin gestations and 352 (11.8%) had monochorionic twin gestations. Patients with monochorionic twins were less likely to self-identify as non-Hispanic White and to have conceived via assisted reproductive technology but were more likely to be publicly insured, multiparous and have prenatal care with a maternal-fetal medicine provider. Neither gestational diabetes mellitus (6.8% monochorionic vs. 6.2% dichorionic,
    Conclusion:  The odds of gestational diabetes mellitus and hypertensive disorders of pregnancy do not appear to differ by twin chorionicity.
    Key points: · Hypertensive disorders of pregnancy do not differ by twin chorionicity.. · Gestational diabetes mellitus does not differ by twin chorionicity.. · Maternal outcomes are similar for individuals with monochorionic and dichorionic twin gestations..
    MeSH term(s) Pregnancy ; Infant, Newborn ; Female ; Humans ; Premature Birth/epidemiology ; Retrospective Studies ; Hypertension, Pregnancy-Induced/epidemiology ; Diabetes, Gestational/epidemiology ; Pregnancy, Twin ; Twins, Dizygotic ; Pregnancy Outcome
    Language English
    Publishing date 2022-01-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/a-1745-3118
    Database MEDical Literature Analysis and Retrieval System OnLINE

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 1929: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  4. Article: The Association of Twin Chorionicity with Maternal Outcomes

    Cowherd, Rachael B. / Cipres, Danielle T. / Chen, Liqi / Barry, Olivia H. / Estevez, Samantha L. / Yee, Lynn M.

    American Journal of Perinatology

    2022  Volume 41, Issue 05, Page(s) 611–617

    Abstract: Objective: Our objective was to investigate the association between maternal outcomes and twin chorionicity in a large, contemporary obstetric population.: Study Design: Retrospective cohort study was conducted at a single, large tertiary care center. ...

    Abstract Objective: Our objective was to investigate the association between maternal outcomes and twin chorionicity in a large, contemporary obstetric population.
    Study Design: Retrospective cohort study was conducted at a single, large tertiary care center. Prenatal and inpatient records for all individuals with twin gestations were reviewed from 2000 to 2016. Patients with monoamniotic twins, higher-order multiples reduced to twins, multiple sets of twins in the study period, or undetermined chorionicity were excluded. Patients with monochorionic twins were compared with those with dichorionic twins. The co-primary outcomes were gestational diabetes mellitus and hypertensive disorders of pregnancy. Secondary outcomes included cesarean delivery, preterm delivery, postpartum hemorrhage, and other maternal outcomes. Bivariate and multivariate analyses were performed to assess associations of chorionicity with maternal outcomes.
    Results: Of the 2,979 patients eligible for inclusion, 2,627 (88.2%) had dichorionic twin gestations and 352 (11.8%) had monochorionic twin gestations. Patients with monochorionic twins were less likely to self-identify as non-Hispanic White and to have conceived via assisted reproductive technology but were more likely to be publicly insured, multiparous and have prenatal care with a maternal–fetal medicine provider. Neither gestational diabetes mellitus (6.8% monochorionic vs. 6.2% dichorionic, p  = 0.74; adjusted odds ratio [OR] 1.06, 95% confidence interval (CI) 0.60–1.86) nor hypertensive disorders of pregnancy (21.9% monochorionic vs. 26.3% dichorionic, p  = 0.09; adjusted OR 0.99, 95% CI, 0.71–1.38) differed by chorionicity. Of the secondary maternal outcomes, patients with monochorionic twins experienced a lower frequency of cesarean delivery (46.0 vs. 61.8%, p  < 0.001), which persisted after multivariate analyses (adjusted OR 0.60, 95% CI 0.46–0.80). There were no differences in preterm delivery, preterm premature rupture of membranes, hemorrhage, hysterectomy, or intrahepatic cholestasis of pregnancy.
    Conclusion: The odds of gestational diabetes mellitus and hypertensive disorders of pregnancy do not appear to differ by twin chorionicity.
    Key Points: Hypertensive disorders of pregnancy do not differ by twin chorionicity. Gestational diabetes mellitus does not differ by twin chorionicity. Maternal outcomes are similar for individuals with monochorionic and dichorionic twin gestations.
    Keywords Chorionicity ; Dichorionic ; Maternal outcomes ; Gestational diabetes ; Hypertensive disorders of pregnancy ; Monochorionic ; Twin gestation
    Language English
    Publishing date 2022-01-19
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/a-1745-3118
    Database Thieme publisher's database

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 1929: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

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