Prospective Risk of Intrauterine Death of Monochorionic-Diamniotic Twins

OBJECTIVE: The purpose of this study was to calculate the prospective risk of fetal death in monochorionic-diamniotic twins. STUDY DESIGN: We evaluated 193 monochorionic diamniotic twin pregnancies that were followed and delivered after 24 weeks. Surveillance included cardiotocography and sonography performed at least once weekly. The prospective risk of fetal death was calculated as the total number of deaths at the beginning of the gestational period divided by the number of continuing pregnancies at or beyond that period. RESULTS: The fetal death rate was 5 of 193 pregnancies (2.6%; 95% CI, 1.1, 5.9); the prospective risk of stillbirth per pregnancy after 32 weeks of gestation was 1.2% (95% CI, 0.3% - 4.2%). CONCLUSION: Under intensive surveillance, the prospective risk of fetal death in monochorionic-diamniotic pregnancies after 32 weeks of gestation is much lower than reported and does not support a policy of elective preterm delivery

Puerperal Complications Following Elective Cesarean Sections for Twin Pregnancies

OBJECTIVE: To estimate the maternal puerperal morbidity in elective and emergent cesareans in twins. STUDY DESIGN: We evaluated postpartum complications among patients who underwent elective cesarean birth for twin pregnancy. This group was compared to matched singletons and to emergent cesareans in twins. RESULTS: During the period September 1994-March 2006 there were 299 (47.4%) elective and 80 (12.7%) emergent cesarean sections in twin pregnancies, for a total of 379 (60.1%) cesarean births for both twins. Controls included 299 cases of elective cesareans in singletons. The comparison between elective and emergent cesareans and between elective cesareans in twins and in singletons found no significant differences in postpartum fever, scar infection, and postpartum hemorrhage. Venous thromboembolism occurred in two twin pregnancies, one in the elective and one in the emergent cesarean group. Postpartum hysterectomy was required in a singleton pregnancy following an elective cesarean birth. CONCLUSION: At present, no data exist to show a disadvantage for a planned cesarean birth for twins.info:eu-repo/semantics/publishedVersio

Perinatal Outcome and Change in Body Mass Index in Mothers of Dichorionic Twins: a Longitudinal Cohort Study

We used a prospective cohort to analyze the effect of change in BMI rather than change in weight, in mothers carrying dichorionic twins from a population that did not receive any dietary intervention. A total of 269 mothers (150 nulliparas and 119 multiparas) were evaluated. The average change (%) from the pre-gravid BMI was 7.2+/-6.1, 17.4+/-8.2, and 28.7+/-10.8, at 12-14, 22-25, and 30-34 weeks, respectively, without difference between nulliparas and multiparas. The comparison between maternities below or above the average change from the pregravid BMI failed to demonstrate an advantage (in terms of total twin birthweight and gestational age) of an above average change from the pregravid BMI, even when the lower versus upper quartiles were compared. Our observations reached different conclusions regarding the recommended universal dietary intervention in twin gestations. A cautious approach is advocated towards seemingly harmless excess weight gain, as normal weight women may turn overweight, or even obese, by the end of pregnancy, and be exposed to the untoward effects of obesity on future health and body image

Birthweight discordance and neonatal morbidity in twin pregnancies: Analysis of the STORK multiple pregnancy cohort.

OBJECTIVES: The main aim of this study was to investigate the relationship between weight discordance and neonatal morbidity in twin pregnancies progressing beyond 34 weeks of gestation. The secondary aim was to determine the predictive accuracy of different weight discordant cut-offs in predicting neonatal morbidity in twin pregnancies. METHODS: This was a retrospective multicentre cohort study of all twin pregnancies booked for antenatal care in four hospitals in the Southwest Thames region of London Obstetric Research Collaborative (STORK) over a period of ten years. The ultrasound data were obtained by a computerized search of each hospital's obstetric ultrasound computer database, while the outcome details were obtained from the computerized maternity and neonatal records. The primary outcome was the incidence of composite neonatal morbidity in twin pregnancies with birthweight discordance. Logistic regression was used to identify and adjust for potential confounders, while the receiver operating characteristic curve was used to determine the predictive accuracy. RESULTS: Nine hundred and thirty-nine twin pregnancies (760 Dichorionic, 179 Monochorionic) were included. The gestation at birth and birthweight decile were significantly lower in the pregnancies complicated by neonatal morbidity compared to those which were not (p<0.001 for both). At multivariable logistic regression, gestation at birth (p<0.001), birthweight decile (p=0.029), birthweight discordance (p=0.019) but not chorionicity (p=0.477) or the presence of at least one small for gestational age twin (p=0.245), were independently associated with the risk of neonatal morbidity. There was a progressive increase in the risk of neonatal morbidity with increasing birthweight discordance. Despite this association, birthweight discordance showed an overall poor predictive accuracy in detecting neonatal morbidity, with an AUC of 0.58 (95% CI 0.53-0.63) with an optimal cut-off of 17.6%, showing a sensitivity and a specificity of 35.2% (95% CI 27.8-43.2) and 83.2% (95% CI 80.0-85.8), respectively. CONCLUSION: Inter-twin birthweight discordance is independently associated with the risk of neonatal morbidity in twins born after 34 weeks' gestation, irrespective of the chorionicity or the diagnosis of SGA in either twin. However, its predictive accuracy for neonatal morbidity is poor

Analysis of factors influencing the ultrasonic fetal weight estimation

Objective: The aim of our study was the evaluation of sonographic fetal weight estimation taking into consideration 9 of the most important factors of influence on the precision of the estimation. Methods: We analyzed 820 singleton pregnancies from 22 to 42 weeks of gestational age. We evaluated 9 different factors that potentially influence the precision of sonographic weight estimation ( time interval between estimation and delivery, experts vs. less experienced investigator, fetal gender, gestational age, fetal weight, maternal BMI, amniotic fluid index, presentation of the fetus, location of the placenta). Finally, we compared the results of the fetal weight estimation of the fetuses with poor scanning conditions to those presenting good scanning conditions. Results: Of the 9 evaluated factors that may influence accuracy of fetal weight estimation, only a short interval between sonographic weight estimation and delivery (0-7 vs. 8-14 days) had a statistically significant impact. Conclusion: Of all known factors of influence, only a time interval of more than 7 days between estimation and delivery had a negative impact on the estimation

Voice Shoppers: From Information Gaps to Choice Gaps in Consumer Markets

Recent years have seen exponential growth in the use of voice shoppers – artificial intelligence–based algorithms installed on digital voice assistants, such as Alexa and Google Assistant, that buy products based on verbal requests received from consumers. This game-changing switch to semi-automated shopping is shaking up markets by reshaping consumer–supplier relationships, as well as the business models of suppliers and search services. Voice shoppers benefit consumers by offering speedier and more sophisticated transactions while reducing search and transaction costs. At the same time, consumers’ voluntary delegation of their search powers and product selection creates what we call a “choice gap,” wherein the voice shopper chooses the product to be offered to the consumer. This gap is distinct from the commonly recognized information gap, which exists when suppliers possess more information than consumers. The choice gap might create a misalignment between consumer preferences and the products actually sold, which harms consumers as well as the function of markets. Yet market forces cannot be relied upon to remedy this market failure. Despite the significant consequences of this market failure, the negative effects of the choice gap are currently undertreated. Consumer protection and antitrust laws are ill-suited to the task. To remedy this, we suggest that transactions conducted by voice shoppers be reviewed under agency law. Agency law enables the application of fiduciary, performance, and information duties that protect consumers’ interests in the transaction, rather than consumer choice. Such duties can reduce the choice gap, improve consumer welfare, and restore market performance. Our findings and suggestions have relevance well beyond voice shoppers, for technologies which completely automate consumer choice without any human involvement, which are the future of commerce

L’oubli au cœur de la mémoire

La société argentine n’est pas si blanche que pourrait le laisser croire le Musée national de l’immigration de Buenos Aires. Nourrie des migrations européennes, elle l’est tout autant des migrations frontalières. Or l’absence des migrants non européens dans ce musée témoigne de leur absence symbolique au sein d’une nation dont ils sont pourtant partie prenante. Par ses choix muséographiques qui réduisent au silence toute une partie de la population argentine, le musée met à jour le contenu problématique du creuset social argentin

Prospective Risk of Intrauterine Death of Monochorionic Twins: Update

Objective: To calculate an updated prospective risk of fetal death in monochorionic-biamniotic (MCBA) twins. Study design: We evaluated 520 MCBA twin pregnancies that had intensive prenatal surveillance and delivered in a single Portuguese referral center. The prospective risk of fetal death was calculated as the total number of deaths at the beginning of the gestational period divided by the number of continuing pregnancies at or beyond that period. Data were compared to the 2006 previous report. Results: Nearly 80% of the neonates weighed <2500 g, including 13.5% who weighed <1500 g. Half were born at <36 weeks, including 13.8% who were born at <32 weeks. The data indicate an increased IUFD rate over time - 16 fetal deaths per pregnancy (3.1%) and 22 IUFDs per fetus (2.1%). The rate of IUFD after 32-33 weeks, however, was halved (1/187 pregnancies and 1/365 fetuses, 0.5 and 0.3%, respectively). Conclusion: Intensive prenatal surveillance might decrease the unexpected fetal death rates after 33 week's gestation and our data do not support elective preterm birth for uncomplicated MCBA twins.info:eu-repo/semantics/publishedVersio

Will the Twain Ever Meet? Military Run Requirements vs. Civilian Run Acquisition

Symposium Presentation (for Acquisition Research Program)Symposium PresentationNaval Postgraduate School Acquisition Research ProgramApproved for public release; distribution is unlimited