Because selective termination for discordant dichorionic twin anomalies carries a risk of pregnancy loss, deferring the procedure until the third trimester can be considered in settings where it is legal.
To determine whether perinatal outcomes were more favorable following deferred rather than immediate selective termination.
A French multicenter retrospective study from 2012 to 2023 on dichorionic twin pregnancies with selective termination for fetal conditions, which were diagnosed before 24 weeks gestation. Pregnancies with additional risk factors for late miscarriage were excluded. We defined 2 groups according to the intention to perform selective termination within 2 weeks after the diagnosis of the severe fetal anomaly was established (immediate selective termination) or to wait until the third trimester (deferred selective termination). The primary outcome was perinatal survival at 28 days of life. Secondary outcomes were pregnancy losses before 24 weeks gestation and preterm delivery.
Of 390 pregnancies, 258 were in the immediate selective termination group and 132 in the deferred selective termination group. Baseline characteristics were similar in both groups. Overall survival of the healthy co-twin was 93.8% (242/258) in the immediate selective termination group vs 100% (132/132) in the deferred selective termination group (P<.01). Preterm birth <37 weeks gestation was lower in the immediate than in the deferred selective termination group (66.7% vs 20.2%; P<.01); preterm birth <28 weeks gestation and <32 weeks gestation did not differ significantly (respectively 1.7% vs 0.8%; P=.66 and 8.26% vs 11.4%; P=.36). In the deferred selective termination group, an emergency procedure was performed in 11.3% (15/132) because of threatened preterm labor, of which 3.7% (5/132) for imminent delivery.
Overall survival after selective termination was high regardless of the gestational age at which the procedure was performed. Postponing selective termination until the third trimester seems to improve survival, whereas immediate selective termination reduces the risk of preterm delivery. Furthermore, deferred selective termination requires an expert center capable of performing the selective termination procedure on an emergency basis if required.

OBJECTIVE: To study the maternal and perinatal outcomes in women with severe pre-eclampsia before 28 weeks of pregnancy.
METHODS: A descriptive study from a tertiary care center. All consecutive women with severe pre-eclampsia withonset before 28 weeks of pregnancy were included. The details were collected in a predesigned structured proforma prospectively.
RESULTS: The study cohort included 145 women with a mean maternal age of 26.97 ± 5.36 years (range 19-47 years). The mean duration of prolongation of pregnancy was 13.04 ± 10.57 days (range 1-51 days). A total of 29.7% (n = 43) of women had at least one major adverse maternal outcome, and the most common was HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome (n = 24,16.6%), followed by eclampsia (n = 12,8.3%). The stillbirth rate was high (n = 103,68.7%), and most occurred in the antepartum period. Of 47 (31.3%) neonates born alive, only eight (17.02%;8/47) survived up to 28 days of life. Fetal growth restriction with Doppler abnormalities and neonatal sepsis were the most common reasons for perinatal mortality.
CONCLUSIONS: Expectant management should not be considered routinely when the onset of severe pre-eclampsia is before 25+6 weeks of pregnancy. Between 26 and 27+6 weeks it can be offered under close monitoring and the perinatal survival depends on the neonatal services available in their facility.

BACKGROUND: The classic mid-trimester preterm premature rupture of membranes (PPROM) is defined as a rupture of the fetal membranes prior to 28 weeks of gestation (WG) with oligo/anhydramnion; it complicates approximately 0.4-0.7% of all pregnancies and is associated with very high neonatal mortality and morbidity. Antibiotics have limited success to prevent bacterial growth, chorioamnionitis and fetal inflammation. The repetitive amnioinfusion does not work because fluid is lost immediately after the intervention. The continuous amnioinfusion through the transabdominal port system or catheter in patients with classic PPROM shows promise by flushing out the bacteria and inflammatory components from the amniotic cavity, replacing amniotic fluid and thus prolonging the PPROM-to-delivery interval.
OBJECTIVE: This multicenter trial aims to test the effect of continuous amnioinfusion on the neonatal survival without the typical major morbidities, such as severe bronchopulmonary dysplasia, intraventricular hemorrhage, cystic periventricular leukomalacia and necrotizing enterocolitis one year after the delivery.
METHODS: We plan to conduct a randomized multicenter trial with a two-arm parallel design. Randomization will be between 22/0 and 26/0 SSW. The control group: PPROM patients between 20/0 and 26/0 WG who will be treated with antibiotics and corticosteroids (from 22/0 SSW) in accordance with the guidelines of German Society of Obstetrics and Gynecology (standard PPROM therapy). In the interventional group, the standard PPROM therapy will be complemented with the Amnion Flush Method, with the amnioinfusion of Amnion Flush Solution through the intra-amnial catheter (up to 100 mL/h, 2400 mL/day).
METHODS: The study will include 68 patients with classic PPROM between 20/0 and 26/0 WG.
BACKGROUND: ClinicalTrials.gov ID: NCT04696003.
BACKGROUND: DRKS00024503, January 2021.

UNASSIGNED: To determine perinatal outcomes and influence of amniotic fluid volume in pregnancies complicated by previable, preterm prelabor rupture of membranes (pPPROM).
UNASSIGNED: This was a historical cohort study from two tertiary-level maternity hospitals (January 1, 2009 to December 31, 2015). All pregnancies complicated by pPPROM were identified using ICD coding of discharge abstracts. Hospital charts were reviewed to collect maternal demographics, pregnancy and delivery events, and immediate postnatal outcomes (including survival). Post-processing review of stored ultrasound images was performed to evaluate the relationship between amniotic fluid volume and outcomes.
UNASSIGNED: A total of 113 pregnancies were eligible and 99 were included in the final analysis (74 with \"expectant management\" and 25 opting for elective termination). The median gestational age at pPPROM was 20+6 weeks [IQR 19+4 to 21+5]. For those choosing expectant management, the median latency between pPPROM and delivery was 7 days, median gestational at delivery was 23+1 weeks, and neonatal survival to discharge was 27.5% overall. There was a trend towards higher rates of pregnancy termination at one hospital (31.7%) compared to the other (15.4%), but no difference between sites with respect to latency, mode of delivery, or survival amongst those managed expectantly. There was a relationship between survival and gestational age at pPPROM (p<0.04), as well as initial amniotic fluid volume category: 52.6% of survivors had normal initial amniotic fluid volumes whereas the majority of previable losses had oligohydramnios and the majority of stillbirths had anhydramnios.
UNASSIGNED: After expectant management, more than one in four newborns following pPPROM survived to hospital discharge. While gestational age at rupture was most strongly correlated with survival, normal initial amniotic fluid volumes were mostly seen in survivors whereas stillbirths more frequently had anhydramnios. These findings will help to improve counseling and care of patients with pPPROM and in guiding long-term follow-up studies.

Neonatal lamb and calf deaths are a major issue in UK agriculture. Consistent mortality rates over several decades, despite scientific advances, indicate that socioeconomic factors must also be understood and addressed for effective veterinary service delivery to improve lamb and calf survival. This qualitative study utilised semi-structured interviews with vets and farmers to explore the on-farm mechanisms and social context, with a particular focus on the role of the vet, to manage and reduce neonatal losses in beef calves and lambs on British farms. Data were analysed using a realist evaluation framework to assess how the mechanisms and context for veterinary service delivery influence survival as the outcome of interest. A lack of a clear outcome definition of neonatal mortality, and the financial, social and emotional impact of losses on both vets and farmers, are barriers to recording of losses and standardisation of acceptable mortality levels at a population level. Despite this, there appears to be an individual threshold on each farm at which losses become perceived as problematic, and veterinary involvement shifts from preventive to reactive mechanisms for service delivery. The veterinarian-farmer relationship is central to efforts to maximise survival, but the social and economic capital available to farmers influences the quality of this relationship. Health inequalities are well-recognised as an issue in human healthcare and the findings indicate that similar inequalities exist in livestock health systems.

The first 28 days of aliveness are the biggest challenge mentioned for the continuity of life for children. In Ethiopia, despite a significant reduction in under-five mortality during the last 15 years, neonatal mortality remains a public health problem accounting for 47% of under-five mortality. Understanding neonatal survival and risk factors for neonatal mortality could help devising tailored interventions. The aim of this study was to determine the neonatal survival and risk factors for neonatal mortality in Aroresa district, Southern Ethiopia.
A community based prospective follow up study was conducted among a cohort of term pregnant mothers and neonates delivered from January 1/2018 to March 30/2018. A total of 586 term pregnant mothers were selected with a multistage sampling technique and 584 neonates were followed-up for a total of 28 days, with 12 twin pairs. Data were coded, entered cleaned and analyzed using SPSS version 22. Kaplan-Meier survival curve was used to show pattern of neonatal death in 28 days. Independent and adjusted relationships of different predictors with neonates\' survival were assessed with Cox regression model. The risk of mortality was explored and presented with hazard ratio and 95% confidence interval and P-value less than 0.05 were considered as significant.
The overall neonatal mortality was 41 per 1000 live births. Hazards of neonatal mortality was high for neonates with complications (AHR = 3.643; 95% CI, 1.36-9.77), male neonates (AHR = 2.71; 95% CI, 1.03-7.09), neonates that mothers perceived to be small (AHR = 3.46; 95% CI, 1.119-10.704), neonates who had initiated exclusive breast feeding (EBF) after 1 h (AHR = 3.572; 95% CI, 1.255-10.165) and mothers who had no postnatal care (AHR = 3.07; 95% CI, 1.16-8.12).
Neonatal mortality in the study area was 4.1% which was high and immediate action should be taken towards achieving the Sustainable Development Goals. To improve neonatal survival, high impact interventions such as promotion of maternal service utilization, essential newborn care and early initiation of exclusive breast feeding were recommended.