Outcomes in intervention and management of multiple pregnancies trials: A systematic review

Farmer, Nicola; Hillier, Megan; Kilby, Mark D.; Morton, Victoria Hodgetts; Morris, RK

doi:10.1016/j.ejogrb.2021.04.025

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…N. Farmer et al [2] öz icmalında əkiz hamiləliklərdə klinik araşdırmaların nəticələrinin mürəkkəbliyini və heterogenliyini, həmçinin nəticələrin və onların göstəricilərinin standartlaşdırmasının yoxluğu vurğulayırlar. Bu icmal müəyyən etdi ki, ana və uşaq (uşaqlar) üçün uzunmüddətli nəticələr nadir hallarda toplanır, valideynlərlə bağlı isə uzunmüddətli nəticələr yalnız 2001-ci ildən bəri tədqiqatlara daxil edilmişdir.…”

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“…əkizdən əkizə qan köçürülməsi (TTTS -twin-to-twin transfusion syndrome) və anemiya-polisitemiya ikiqat ardıcıllığı (TAPS -twin anemia-polythaemia sequence) daxildir. Bu, bətndaxili xəstəlik və ölüm riskini əhəmiyyətli dərəcədə artırır, həmçinin bildirilən nəticələrdə böyük fərqlər olmasına görə əkizlərdə tədqiqatları çətinləşdirir [2].…”

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Əkiz hamiləliyin fəsadları və taktikarı

C.F. Gurbanova,

A.F. Amirova,

Kh.M. Takhmazi

et al. 2023

modern gynecology

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Əkiz hamiləliklər ana və uşaq (uşaqlar) üçün mənfi nəticələr riskinin artması ilə yayılmış hal olaraq qalır. Əkiz hamiləlik, uzun sürən hamiləlik və makrosomiya istisna olmaqla, demək olar ki, bütün potensial hamiləlik ağırlaşmalarının yüksək tezliyi ilə, eləcə də bəzi unikal fəsadlarla bağlıdır.Əkiz hamiləliklərdə ananın həddindən artıq risklərinə anemiya, sidik yollarının infeksiyası, hipertoniya, hestasiya diabet, qanaxma və ana ölümü daxildir və tək hamiləliklərə nisbətən daha diqqətli monitorinq tələb olunur.

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Əkiz hamiləliyin fəsadları və taktikarı

C.F. Gurbanova,

A.F. Amirova,

Kh.M. Takhmazi

et al. 2023

modern gynecology

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Balancing key stakeholder priorities and ethical principles to design a trial comparing intervention or expectant management for early-onset selective fetal growth restriction in monochorionic twin pregnancy: FERN qualitative study

Mitchell,

Popa,

Ashcroft

et al. 2024

BMJ Open

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ObjectivesAs part of the FERN feasibility study, this qualitative research aimed to explore parents’ and clinicians’ views on the acceptability, feasibility and design of a randomised controlled trial (RCT) of active intervention versus expectant management in monochorionic (MC) diamniotic twin pregnancies with early-onset (prior to 24 weeks) selective fetal growth restriction (sFGR). Interventions could include laser treatment or selective termination which could lead to the death or serious disability of one or both twins.DesignQualitative semi-structured interviews with parents and clinicians. Data were analysed using reflexive thematic analysis and considered against the Principles of Biomedical Ethics.Participants and settingWe interviewed 19 UK parents experiencing (six mothers, two partners) or had recently experienced (eight mothers, three partners) early-onset sFGR in MC twin pregnancy and 14 specialist clinicians from the UK and Europe.ResultsParticipants viewed the proposed RCT as ‘ethically murky’ because they believed that the management of sFGR in MC twin pregnancy should be individualised according to the type and severity of sFGR. Clinicians prioritised the gestational age, size, decrease in growth velocity, access to the placental vessels and acceptability of intervention for parents. Discussions and decision-making about selective termination appeared to cause long-term harm (maleficence). The most important outcome for parents and clinicians was ‘live birth’. For clinicians, this was the live birth of at least one twin. For parents, this meant the live birth of both twins, even if this meant that their babies had neurodevelopmental impairment or disabilities.ConclusionsAll three pregnancy management approaches for sFGR in MC twin pregnancy carry risks and benefits, and the ultimate goal for parents is to receive individualised care to achieve the best possible outcome for both twins. An RCT was not acceptable to parents or clinicians or seen as ethically appropriate. Alternative study designs should be considered to answer this important research question.

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The science of uncertainty guides fetal-neonatal neurology principles and practice: diagnostic-prognostic opportunities and challenges

Scher

2024

Front. Neurol.

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Fetal-neonatal neurologists (FNNs) consider diagnostic, therapeutic, and prognostic decisions strengthened by interdisciplinary collaborations. Bio-social perspectives of the woman’s health influence evaluations of maternal-placental-fetal (MPF) triad, neonate, and child. A dual cognitive process integrates “fast thinking-slow thinking” to reach shared decisions that minimize bias and maintain trust. Assessing the science of uncertainty with uncertainties in science improves diagnostic choices across the developmental-aging continuum. Three case vignettes highlight challenges that illustrate this approach. The first maternal-fetal dyad involved a woman who had been recommended to terminate her pregnancy based on an incorrect diagnosis of an encephalocele. A meningocele was subsequently identified when she sought a second opinion with normal outcome for her child. The second vignette involved two pregnancies during which fetal cardiac rhabdomyoma was identified, suggesting tuberous sclerosis complex (TSC). One woman sought an out-of-state termination without confirmation using fetal brain MRI or postmortem examination. The second woman requested pregnancy care with postnatal evaluations. Her adult child experiences challenges associated with TSC sequelae. The third vignette involved a prenatal diagnosis of an open neural tube defect with arthrogryposis multiplex congenita. The family requested prenatal surgical closure of the defect at another institution at their personal expense despite receiving a grave prognosis. The subsequent Management of Myelomeningocele Study (MOMS) would not have recommended this procedure. Their adult child requires medical care for global developmental delay, intractable epilepsy, and autism. These three evaluations involved uncertainties requiring shared clinical decisions among all stakeholders. Falsely negative or misleading positive interpretation of results reduced chances for optimal outcomes. FNN diagnostic skills require an understanding of dynamic gene-environment interactions affecting reproductive followed by pregnancy exposomes that influence the MPF triad health with fetal neuroplasticity consequences. Toxic stressor interplay can impair the neural exposome, expressed as anomalous and/or destructive fetal brain lesions. Functional improvements or permanent sequelae may be expressed across the lifespan. Equitable and compassionate healthcare for women and families require shared decisions that preserve pregnancy health, guided by person-specific racial-ethnic, religious, and bio-social perspectives. Applying developmental origins theory to neurologic principles and practice supports a brain health capital strategy for all persons across each generation.

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Outcomes in intervention and management of multiple pregnancies trials: A systematic review

Cited by 3 publications

References 25 publications

Əkiz hamiləliyin fəsadları və taktikarı

Əkiz hamiləliyin fəsadları və taktikarı

Balancing key stakeholder priorities and ethical principles to design a trial comparing intervention or expectant management for early-onset selective fetal growth restriction in monochorionic twin pregnancy: FERN qualitative study

The science of uncertainty guides fetal-neonatal neurology principles and practice: diagnostic-prognostic opportunities and challenges

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