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Background: The present study aimed to explore the maternal and perinatal risks in cases of monozygotic twins (MZT) following frozen-thawed embryo transfer (FET)., Methods: All twin births that were conceived following FET from 2007 to 2021 at Shanghai Ninth People's Hospital in Shanghai, China were retrospectively reviewed. The exposure variable was twin type (monozygotic and dizygotic). The primary outcome was the incidence of neonatal death while secondary outcomes included hypertensive disorders of pregnancy, gestational diabetes, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, preterm premature rupture of the membranes, Cesarean delivery, gestational age, birth weight, weight discordance, stillbirth, birth defects, pneumonia, respiratory distress syndrome, necrotizing enterocolitis, and neonatal jaundice. Analysis of the outcomes was performed using logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The causal mediation analysis was conducted. A doubly robust estimation model was used to validate the results. Kaplan-Meier method was used to calculate survival probability. The sensitivity analysis was performed with a propensity score-based patient-matching model., Results: Of 6101 dizygotic twin (DZT) and 164 MZT births conceived by FET, MZT showed an increased risk of neonatal death based on the multivariate logistic regression models (partially adjusted OR: 4.19; 95% CI, 1.23-10.8; fully adjusted OR: 4.95; 95% CI, 1.41-13.2). Similar results were obtained with the doubly robust estimation. Comparing MZT with DZT, the neonatal survival probability was lower for MZT (P < 0.05). The results were robust in the sensitivity analysis. Females with MZT pregnancies exhibited an elevated risk of preterm premature rupture of the membranes (adjusted OR: 2.42; 95% CI, 1.54-3.70). MZT were also associated with higher odds of preterm birth (prior to 37 weeks) (adjusted OR: 2.31; 95% CI, 1.48-3.67), low birth weight (adjusted OR: 1.92; 95% CI, 1.27-2.93), and small for gestational age (adjusted OR: 2.18; 95% CI, 1.21-3.69) in the fully adjusted analyses. The effect of MZT on neonatal death was partially mediated by preterm birth and low birth weight (P < 0.05)., Conclusions: This study indicates that MZT conceived by FET are related to an increased risk of neonatal death, emphasizing a potential need for comprehensive antenatal surveillance in these at-risk pregnancies., (© 2024. The Author(s).)

Background: Previous studies have reported that ambient temperature may affect perinatal outcomes. However, whether extreme temperature affects the risk of preterm birth (PTB) remains controversial. Studies on the associations of extreme temperature with PTB subtypes are lacking., Objectives: We aimed to investigate the associations of extreme climate events with the risks of PTB and its subtypes, discerning possible modifiers., Methods: Data on all singleton deliveries were obtained from the China Labor and Delivery Survey (CLDS), a nationwide investigation implemented in 2015 and 2016. PTB was defined as gestational weeks < 37 and then categorized as early (24-34 wk) and late PTBs (35-36 wk), and clinical subtypes [spontaneous PTB, preterm premature rupture of the fetal membranes (PPROM), iatrogenic PTB]. Ambient temperature data were provided by the China National Weather Data Sharing System. Five heat indexes and five cold indexes were used to define heat waves and cold spells. Generalized linear mixed models with a random term by hospital unit were used to assess the associations of short-term prenatal extreme temperature exposure. The Cox proportional hazard regression model was applied to assess the nonlinear associations of low- or high-temperature exposure at the whole and different trimesters of pregnancy with the risk of PTB. Stratified analyses were conducted to assess the possible modification by geographic region and fetal sex., Results: A total of 70,818 singleton births from 96 hospitals in China were included, among which 4,965 (7.01%) were PTBs. Exposure to extreme cold events 1 wk before delivery was associated with an increased PTB risk, with an adjusted odds ratio (aOR) [95% confidence intervals (CIs)] of 1.07 (95% CI: 1.04, 1.10) and 1.06 (1.04, 1.09) for the total days when the daily average temperature below the fifth percentile (fifth-days) and the 10th percentile (10th-days), 1.18 (1.04, 1.34) for the cold spells when the daily average temperature below the fifth percentile for two consecutive days (fifth-2D), 1.09 (1.03, 1.16) and 1.12 (1.06, 1.19) for the cold spells when the daily average temperature below the 10th percentile for three and two consecutive days (10th-3D and 10th-2D), respectively. Results of extreme temperature exposure during 2 weeks before delivery showed similarly significant associations. The association between cold spells and PTB tended to be stronger for late PTB than for early PTB. Cold spells were mainly associated with spontaneous PTB and late PPROM. A stratified analysis indicated that pregnant women in western and northern regions tended to be more sensitive to cold spells, and pregnant women with a female fetus appeared to be at a higher risk of PTB when exposed to cold spells. Pregnant women in late pregnancy were more susceptible to extreme temperatures. No significant or stable association was found between heat waves and preterm birth., Discussion: Exposure to cold spells was associated with an increased risk of PTB, especially late, spontaneous PTB and PPROM. The associations appeared to be more pronounced in the north and west regions and in pregnancies with female fetuses. https://doi.org/10.1289/EHP10831.

Objective: To investigate reliable biomarkers for predicting histological chorioamnionitis (HCA) in women with preterm prelabour rupture of membranes (PPROM)., Design: A retrospective study., Setting: A maternity care hospital in Shanghai., Population: Women with PPROM before 34 +0/7  weeks of gestation., Methods: Mean values of biomarkers were compared by two-way analysis of variance (ANOVA). Log-binomial regression models were used to assess the association between biomarkers and risk of HCA. A stepwise logistic regression model was used to develop a multi-biomarker prediction model and identify the independent predictors. The area under the receiver operating characteristic curve (AUC) was used to assess prediction performance., Main Outcome Measures: The ability of the individual biomarker and the combination of multiple biomarkers to predict HCA., Results: In 157 mothers with PPROM, 98 (62.42%) women had HCA and 59 (37.58%) women did not have HCA. No significant differences were observed between the two groups in white blood cell, neutrophil or lymphocyte counts, whereas both high-sensitivity C-reactive protein (hsCRP) and procalcitonin (PCT) were significantly higher in the HCA group. HsCRP and PCT were found to be independently associated with the risk of HCA, and PCT had a larger AUC value than hsCRP (p < 0.05). The optimal multi-biomarker prediction model for HCA (AUC = 93.61%) included hsCRP at 72 hours and PCT at 48 and 72 hours, and PCT had a stronger prediction capacity than hsCRP., Conclusions: PCT could be a reliable biomarker for the early prediction of HCA in women with PPROM within 72 hours of dexamethasone treatment., (© 2023 John Wiley & Sons Ltd.)

Objective: The aim is to examine risk factors and neonatal outcomes of preterm birth and to provide basis in preventing preterm birth., Materials and Methods: we carried out our study on 1328 term controls and 1328 preterm birth cases. By using multivariable logistic regression procedures we estimated odds ratio (OR) of potential preterm birth risk factors. T-test and chi-square test were used to estimate differences between groups., Results: Maternal age, prior history of pregnancy and abortion, prenatal care, complications of pregnancy (includes hypertension, intrahepatic cholestasis of pregnancy (ICP), fetal growth restriction (FGR), premature rupture of the membranes (PROM), placenta previa, abnormal presentation, abnormal S/D ratio et al.) were significantly associated with preterm birth. Several factors emerged as being statistically significant risk factors for preterm birth, such as prior history of pregnancy, hypertension, ICP, FGR, PROM, placenta previa and abnormal presentation. The time of prenatal care was shown to be a protective factor. Additionally, we observed evidence suggested that male babies are known to have a significant higher risk of preterm birth than female babies., Conclusion: Prior history of pregnancy, hypertension, ICP, FGR, PROM, placenta previa and abnormal presentation were covariates identified in this study as risk factors for preterm birth. Preterm birth is an important reason of neonatal poor prognosis and death., (Copyright © 2018. Published by Elsevier B.V.)

Objective: To evaluate pregnancy outcomes after selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS)., Methods: A total of 33 cases of TTTS were treated by SFLP in Shanghai First Maternity and Infant Hospital from January 2012 to August 2013. Clinical data on perinatal outcomes, fetaland maternalcomplicationswere recorded and retrospectively analyzed., Results: (1) The mean gestational age for SFLP was (22.0 ± 2.3) weeks, the mean time for SFLP was (86 ± 32) minutes, the mean gestational age for delivery was 33(+6) weeks, the gestational age between SFLP and delivery was (9 ± 5) weeks. (2) The perinatal survival rate 28 days after the delivery was 70% (46/66). The survival rate was 52% (17/33) for both twins, 36% (12/33) for one twin, 88% (29/33) for at least one twin. Of all the survival twins, there were 21 donor twins (64%, 21/33) with the mean birth weight at delivery was (1 805 ± 523) g and 25 recipient twins (76%, 25/33) with the mean birth weight (2 214 ± 600) g. (3) There were 4 cases at TTTS stage I, 9 at TTTS stage II, 11 at TTTS stage III, 9 at TTTS stage IV; the survival number for at least one twin was 4, 7, 10, 8 respectively; the total survival rate was 7/8, 12/18, 68% (15/22), 12/18 respectively. (4) Four cases had both twins demises. 3 fetuses had special fetal complications with 2 of them developing twin anemia-polycythemia sequence (TAPS). Two cases had preterm premature rupture of membrane (PPROM) within 3 weeks after SFLP. (5) Placental injections were performed in 7 cases with SFLP after delivery. Residual anastomosis was identified in one case., Conclusion: As an emerging center, our study demonstrated favorable fetal outcomes with less maternal complications after SFLP for TTTS.

The aim of the study was to find out the neonatal outcome of infants born with history of preterm premature rupture of membrane (PPROM) and to compare with infants born without history of PPROM. It was a retrospective study that included 187 preterm newborn with history of PPROM admitted in neonatal intensive care unit of the third affiliated hospital of Zhengzhou University from January 2008 to December 2008. Another 150 preterm newborns from same department during same period were taken as control. Patient demographics, patient's problem, investigation, management and outcome were recorded from medical record department and compared. Chi square and t test were used for statistical analysis. There was no statistical difference of gestational age, mode of delivery, birth weight and gender between case and control group. Respiratory system related problems like birth asphyxia, respiratory distress syndrome, apnea and pneumonia were common in both group but not statistical significant (p>0.05). However, need of oxygen supply and mechanical ventilation was significantly more (p<0.05) in case group. Neonatal death was more in case group (5.3%) than in control group (0.7%) and was statistically significant (p<0.001). The morbidity of preterm neonate does not entirely depend on history of PPROM than prematurity itself. However severity of disease and death is more with history of PPROM.