Outcomes in Spontaneous and ART Twin Pregnancies

Study Overview
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Brief Summary
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During the last decades, assisted reproductive technique has been transformed from a miracle to real and has become widely used for treatment human infertility. this was associated with increased the rate of twin pregnancies

Detailed Description
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Twin pregnancies are associated with an increased risk of maternal mortality & morbidity and an increase in the incidence of neonatal morbidity and mortality compared to singleton pregnancy. The heterogeneous results reported so far can also depend on differences in the studied populations and/or in the management approach to twin pregnancy, variability in data regarding neonatal and maternal outcomes. Evidence on pregnancy outcomes of twins conceived by artificial reproductive technology (ART) compared with those naturally conceived (NC) is conflicting, A 2004 systematic review and a large 2008 study both were praised that in cases of twin pregnancy after assisted conception the perinatal mortality is significantly lower, when compared with those spontaneously conceived .

Official Title
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Maternal and Perinatal Outcomes in Spontaneous Twins Versus Twins Conceived by Ovulation Induction and Assisted Reproductive Techniques: A Cross Section Study Within One Year

Conditions
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Neonatal SEPSIS, Perinatal Mortality, Maternal Morbidity

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Twin delivered >24-week gestational age weight ≥ 500g Diachronic diamniotic twins. Exclusion Criteria: Intrauterine fetal deaths Higher-order multiple pregnancies Deliveries complicated by early vanishing fetuses Twin pregnancies reduced to singleton Triple pregnancy reduced to twin.
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maternal diabetes using glucose tolerance test | The diagnosis of GDM was based a fasting plasma glucose level of ≥5.6 mmol/L with 2 h plasma glucose level of ≥7.8 mmol/L | up to 7 days postpartum | 
| Hypertension during pregnancy and preeclampsia diagnosed using ACOG guideline a) weight in kilogram b) Apgar score in first and 10th minutes c)Admission to neonatal intensive acre unit measured in days | Systolic and diastolic blood pressure equal or more than140/90 mm Hg measured on two or more occasions after 20 weeks of gestation in previously normotensive women, with or without proteinuria (proteinuria of >100 mg/dL by urine analysis, or >300 mg/24 h) | up to 1 week postpartum | 
| Maternal anemia using WHO criteria | Hemoglobin level less than 11gm/dl | up to 1 week | 
| Postpartum hemorrhage | Bleeding from genital tract of 500 mL or more vaginally | up to 1 week | 
| Neonatal weight in kilogram | categorized as extreme low birth weight (LBW) for <1000 g, very LBW for 1000-1500 g, LBW for 1500-2500 g, and normal birth weight for >2500 g | up to 7 days | 
| Neonatal Apgar(Appearance, Pulse, Grimace, Activity, and Respiration) score | Apgar scores includes 10 sores , 2 for each . The Apgar score was classified as severely depressed <0-3>, moderately depressed<4-6> and excellent condition<7-10> | first and fifth minute of life | 
| Admission to neonatal care unit in days | Fetal care unit | up to 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maternal mode of delivery | Cesarean section or vaginal delivery | during labor | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Twins, ART, Induction of Ovulation, Perinatal mortality