Search

Objective: To assess the success rate of vaginal delivery among women with twin pregnancies; the Twin Birth Study has shown that vaginal delivery and caesarean section are equally safe for twin delivery but >40% of the planned vaginal delivery group delivered by caesarean section.Design: A retrospective cohort study.Setting: A tertiary medical centre.Population: A total of 2194 women with twin pregnancies not complicated with very low birthweight.Methods: Planned mode of delivery was documented in the woman's electronic record upon entering the delivery room. Information regarding maternal age at delivery, parity, gestational age, presentation, previous history of caesarean delivery, birthweight and Apgar score was collected from the obstetric electronic charts.Main Outcome Measured: Rate of vaginal twin delivery.Results: Of the 2194 women included, 1311 twin pregnancies had planned caesarean delivery and 883 underwent a trial of labour. Of the 883 women who underwent a trial of labour, the rate of vaginal delivery was 86.9%, whereas the rates of caesarean delivery and combined vaginal-caesarean delivery were 11.1% and 2.0%, respectively. Presentation of second twin, gestational age and maternal age did affect the chances of success. Nulliparity [odds ratio (OR) 2.38, 95% confidence interval (95% CI) 1.4-4.05], Foley induction of labour (OR 2.33, 95% CI 1.38-3.91) and body mass index >30 kg/m(2) (OR 1.76, 95% CI 1.03-3) were independent risk factors for caesarean delivery.Conclusions: The rate of vaginal delivery among women with twin pregnancies who undergo labour can be high, especially in women who laboured spontaneously and have delivered before.Tweetable Abstract: The rate of vaginal delivery of twins can be high, especially in women who have delivered before. [ABSTRACT FROM AUTHOR]

In 6/23 (26%) pregnancies and 7/46 (15.2%) fetuses pre or postnatal brain lesions were detected, of whom five were the polycythemic twins and two were the anemic twins. Pregnancies were followed with fetal brain neurosonogram every 2 weeks and fetal brain MRI (magnetic resonance imaging) was performed when indicated at 28-32 weeks of gestation; postnatal brain imaging included neonatal brain ultrasound. To determine the rate of fetal and neonatal brain lesions and define risk factors for such lesions in pregnancies complicated by twin anemia polycythemia sequence (TAPS). [Extracted from the article]

Conclusions Abnormal fetal growth of the smaller twin in type 3 sFGR was evident from early in pregnancy, while the larger twin's growth remained normal throughout gestation. We aimed to assess fetal growth and Doppler patterns in type 3 sFGR across gestation and evaluate the effect of changing Doppler flow patterns on growth and intertwin weight discordance. OP04.02: Growth patterns of monochorionic twin pregnancies complicated by type-3 selective fetal growth restriction. [Extracted from the article]

Sand and dust storms increasingly threaten global environmental and public health. To date, 150 countries are directly affected, with more than 100 classified as non-dust source regions. With climate change, these storms are expected to become more frequent and severe. Despite international awareness and initiatives, such as those led by the UN, crucial knowledge gaps continue to hinder effective, evidence-based public responses to sand and dust storms. In this Viewpoint, we review existing gaps in health research and highlight four key research priorities: the comprehensive health effects of sand and dust storms, including short-term and long-term exposures, diseases, regions, and health outcomes; the key particle sizes and toxic components of particles during sand and dust storms; the design of multicentre studies accounting for region-specific exposure patterns; and research on health outcomes attributable to particulate matter mixtures dominated by windblown dust versus other sources. We urgently call for international, collaborative, and multidisciplinary health studies considering sand and dust storm exposure characteristics and for the adoption of scientifically robust epidemiological methods in these studies., Competing Interests: Declaration of interests PP is employed by the Health Effects Institute, a non-profit corporation that receives balanced funding from the United States Environmental Protection Agency, the worldwide motor vehicle industry, and philanthropic organisations, and serves as Chair of the Governing Board for OpenAQ, a non-profit organisation providing universal access to air quality data. This is a voluntary position with no financial renumeration. All other authors declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Research Question: What is the relationship between sonographic diagnosis of isolated adenomyosis and placenta-associated obstetric outcomes?, Design: In this 12-year retrospective cohort study (2010-2022), patients presenting with adenomyosis-related symptoms were assessed via ultrasound. The study included 59 women diagnosed with adenomyosis and 62 controls, leading to 203 births (90 in the adenomyosis group and 113 in the control group). Patients with endometriosis, uterine fibroids and anomalies, and those using assisted reproductive technology were excluded. The primary outcome focused on a composite of placenta-associated adverse outcomes, including preterm birth, small-for-gestational-age fetuses, hypertensive disorders of pregnancy, placental abruption and post-partum haemorrhage., Results: No clinically significant differences in demographic characteristics were noted between the two groups. However, the adenomyosis group showed a significantly higher rate of adverse placental function outcomes (27%) compared with the control group (11%, P = 0.005). Adjusted analyses for maternal age, parity and aspirin usage revealed increased risk of hypertensive disorders (adjusted OR 5.91, 95% CI 1.50-30.0; P = 0.017) and adverse placental function outcomes (adjusted OR 3.44, 95% CI 1.53-8.09; P = 0.003) in the adenomyosis group., Conclusion: Adenomyosis is significantly associated with increased risk of adverse placental function outcomes and hypertensive disorders of pregnancy. These findings suggest that adenomyosis may have a distinct impact on pregnancy, underscoring the need for further research to elucidate specific sonographic characteristics of adenomyosis and their effects on placental function., (Copyright © 2024 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

The atmosphere hosts a microbiome that connects distant ecosystems yet remains relatively unexplored. In this study, we tested the hypothesis that dust storms enhance the spread of pathogenic microorganisms and whether these microorganisms carry antibiotic resistance and virulence-related genes in the Eastern Mediterranean. We collected air samples during a seasonal transition period, capturing data from 13 dusty days originating from Middle Eastern sources, including the Saharan Desert, Iraq, Iran, and Saudi Arabia, and 32 clear days, with temperatures ranging from 16.5 to 27.1 °C. Using metagenomic analysis, we identified several facultative pathogens like Klebsiella pneumoniae, Stenotrophomonas maltophilia, and Aspergillus fumigatus, which are linked to human respiratory diseases, and others like Zymoseptoria tritici, Fusarium poae, and Puccinia striiformis, which are harmful to wheat. The abundance of these pathogens increased during dust storms and with rising temperatures. Although we did not find strong evidence that these species harbored antibiotic resistance or virulence-related genes, which could be linked to their pathogenic potential, dust storms transported up to 125 times more total antibiotic resistance genes, as measured by RPKM abundance, compared to clear conditions. These levels during dust storms far exceeded those found in other ecosystems. While further research is needed to determine whether dust storms and temperature variations pose an immediate threat to public health and the environment, our findings underscore the importance of continuous monitoring of atmospheric microbiomes. This surveillance is crucial for assessing potential risks to human health and ecosystem stability, particularly in the face of accelerating global climate change., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The increasing exposure to biomass-burning emissions underscores the need to understand their toxicological impacts on human health. In this study, we developed a laboratory model to evaluate the effects of single and repeated sub-acute exposures to water-soluble wood tar (WT) extracts, a product of biomass burning, on human lung, liver, and immune cells. Using representative cell lines for different tissues, we examined the cytotoxic effects under conditions mimicking sub-acute environmental exposure levels relevant to humans. Our findings indicate that repeated sub-acute exposures to water-soluble WT extracts significantly enhance the inflammatory response, evidenced by increased IL6, IL8, and TNFa cytokine levels, compared to a single exposure. Additionally, oxidative stress responses were more pronounced with increased lipid peroxidation and HMOX1, GCLC and CYP1A1 gene expression following repeated exposures. Metabolomics analyses of polar and lipid metabolites revealed changes related to energy production and consumption that emerge even after a single exposure at sub-acute levels and vary across different cell types representing the different tissues. Impaired cellular respiration, measured by oxygen consumption rate, corroborates the observed changes. These results provide important insights into the cellular mechanisms driving the response to biomass-burning exposure and highlight the potential health risks associated with sub-acute exposure to environmental pollutants., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Prof. Yinon Rudich reports financial support was provided by Pudgin Memorial Trust, Estate of Herbert Hoffer, Estate of Renee Lebed, Fran Morris Rosman and Richard Rosman, Mr. and Mrs. Les E. Lederer, Merle S. Cahn Foundation and The Donald Gordon Foundation. Prof. Yinon Rudich reports financial support was provided by German Israeli Foundation for Scientific Research and Development. Prof. Yinon Rudich reports financial support was provided by Horizon Europe. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Occiput posterior position is associated with labor arrest, need for operative delivery, and failed instrumental vaginal delivery, with resulting adverse peripartum outcomes. Vacuum extraction is the most commonly performed type of instrumental delivery worldwide., Objective: This study aimed to investigate the outcome of vacuum extraction in fetuses with sonographically confirmed occiput posterior position before the procedure., Study Design: Singleton pregnancies at term with sonographically confirmed fetal occiput posterior position before the vacuum extraction were enrolled in 3 academic maternity units. Fetal head station was assessed using transperineal sonography measuring the angle of progression and the head-perineum distance. The primary outcome was failed vacuum extraction, defined as the need for cesarean delivery. Secondary outcomes included adverse maternal and/or adverse neonatal outcomes and complicated vacuum extraction, with the latter defined as failed vacuum extraction or at least 3 out of the following 6 parameters: 5-minute Apgar score <7, neonatal acidemia, admission to the neonatal intensive care unit, neonatal trauma, postpartum hemorrhage, and obstetrical anal sphincter injuries., Results: Among the 98 patients included in the study, vacuum extraction was successful in 94 (96%). Logistic regression analysis showed that the measurement of the head-perineum distance was the only factor independently associated with failed vacuum extraction (odds ratio, 1.25; 95% confidence interval, 1.02-1.55; P=.03), with an area under the curve of 0.79 (P=.04). A head-perineum distance cutoff value of 38.5 mm discriminated between successful and failed vacuum extraction, yielding a sensitivity of 75.0% (3/4), specificity of 84.0% (79/94), positive likelihood ratio of 4.7, and negative likelihood ratio of 0.3., Conclusion: Vacuum extraction is successful in 95% of fetuses with occiput posterior position confirmed at ultrasound. The head-perineum distance measured at transperineal ultrasound has a significant albeit weak association with the outcome of vacuum extraction., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)