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Similar best-practice guidelines should be outlined for other infertility treatments that use ARTs,
such as ovulation induction. Rasmussen and colleagues (2001) examined more than 250,000 infants
with known gestational ages born between 1989 and 1995 in the Atlanta, Georgia, metropolitan area.
The implications of being born too soon extend beyond the neonatal period throughout the life cycle.
Prior strategies shown to be ineffective are discouraged unless new evidence emerges. The birth of a
preterm infant can also bring considerable emotional and economic costs to families and have
implications for public-sector services, such as health insurance, educational, and other social support
systems. Neonatal treatment with surfactant is an effective adjunctive therapy that adds
independently and synergistically to the benefit offered by corticosteroids in reducing respiratory
distress syndrome-related morbidity (St. Drugs can be used to accelerate maturation of the fetus,
and to a greater extent by preventing preterm birth. Functioning in accordance with general policies
determined by the Academy, the Council has become the principal operating agency of both the
National Academy of Sciences and the National Academy of Engineering in providing services to
the government, the public, and the scientific and engineering communities. The members of the
committee responsible for the report were chosen for their special competences and with regard for
appropriate balance. Microbes and the Inflammatory Response in Necrotising Enterocolitis By
Heather J.L. Brooks, Michelle A. McConnell and Roland S. The committee thanks the numerous
individuals and organizations who generously provided information and assistance during delib. In
low- and middle-income countries, there are common myths and misconceptions that have restricted
attention and the implementation of interventions to prevent preterm birth and improve the survival
and outcome of premature babies (Figure 4 ). Don’t get too emotional when talking about social,
political and economical conditions related to medical conditions, etc. For twins, the average
gestational age at delivery is approximately 35 weeks, with 58 percent of these deliveries occurring
before term (37 weeks of gestation) and with more than 12 percent occurring before 32 weeks of
gestation (CDC, 2003d) ( Figure 5-6 ). Dr. Ralph J. Cicerone is president of the National Academy
of Sciences. Sign up for email notifications and we'll let you know about new publications in your
areas of interest when they're released. It hyperpolarizes the plasma membrane and inhibits myosin
light-chain kinase activity by competing with intracellular calcium at this site. This condition when
combined with a maternal diabetic pregnancy, can lead to transient hypoglycemia during the first
days of life. The analyses excluded women with chronic illness, multiple fetuses, and unplanned
pregnancies. The National Academy of Engineering also sponsors engineering programs aimed at
meeting national needs, encourages education and research, and recognizes the superior
achievements of engineers. Limiting indomethacin therapy to 24 to 48 hours of treatment before 32
weeks of gestation avoids these concerns (Moise et al., 1988). Oxytocin receptor antagonists In
normal parturition, oxytocin stimulates contractions by inducing the conversion of
phosphatidylinositol to inositol triphosphate, which binds to a protein in the sarcoplasmic reticulum
that causes the release of calcium into the cytoplasm. Other states address the prevention of abuse by
practitioners and regulate gamete and embryo donations. You can download the paper by clicking the
button above. I would obviously use my personal twins’ story as an example and then the data I’ve
collected in my NEC study. The action plan is expected to be released in May 2014 at the WHO
World Health Assembly. Non-college educated women were more likely to experience problems with
infertility and impaired fecundity than women with 4-year college degrees. HMGB1 expression was
increased in PE relative to physiological p. This goal is important, because the continuation of preg
nancy in women with preterm parturition in some instances may increase the health risk for the
mother or the fetus, or both. Dr. Wm. A. Wulf is president of the National Academy of Engineering.
The relationship between preterm birth and birth defects was also analyzed by smaller gestational age
categories (20 to 28 weeks, 29 to 32 weeks, 33 to 34 weeks, and 35 to 36 weeks).
A study from the First And Second Trimester Evaluation of Risk trial examined whether the use of
ART was associated with an increased risk of chromosomal abnormalities, fetal malformations, or
adverse pregnancy outcomes among singleton births (Shevell et al., 2005). Approximately 95 percent
of patients did not use any form of ART, 3.4 percent used ovulation induction, and 1.5 percent
received IVF treatment. The study samples have not been large enough for sufficient investigations
of morbidity, mortality, and neurological morbidity. Of 197 eligible publications, few (10.7%) were
high quality (CHERG). Development of an effective prediction model may permit the evaluation of
targeted therapies, such as the provision of supplemental progesterone (described below). Donald
Mattison, Scott Grosse, and Samuel Posner, who served as project officers and who were
instrumental in the initiation of this activity. I would like to recommend the following IntechOpen
book to be added to our library catalog. The increase in cGMP content in smooth muscle cells
activates myosin light-chain kinases, leading to smooth muscle relaxation (Yallampalli et al., 1998).
NO donors such as nitroglycerin inhibit spontaneous and oxytocin- and prostaglandin-induced
activity in vitro and effectively inhibit postsurgical uterine contractility in pregnant monkeys and
humans. The Institute of Medicine was established in 1970 by the National Academy of Sciences to
secure the services of eminent members of appropriate professions in the examination of policy
matters pertaining to the health of the public. Figure 6 The Continuum of Care for reproductive,
maternal, newborn and child health through the life cycle according to levels of health service
delivery. The review of this report was overseen by NANCY E. ADLER. Appointed by the National
Research Council, she was responsible for making certain that an independent examination of this
report was carried out in accordance with institutional procedures and that all review comments were
carefully considered. NIH Consens Statement. 1994;12:1-24. 5. Society for Maternal-Fetal Medicine
(SMFM) Publications Committee. Some investigators have speculated about the effects of fertility
drugs on the risk of breast cancer and cancers of the reproductive system. Maternal illnesses can alter
or limit the placental delivery of oxygen and nutrients to the developing fetus, possibly resulting in
fetal growth restriction. Results revealed similar implantation and live birth rates and a significant
reduction in the number of twins conceived with single embryo transfer (Criniti et al., 2005). In the
first section of this book we present an update on the association of periodontal disease, maternal
stress, a. Implementation of the use of antenatal corticosteroids in the late preterm birth period in
women at risk for preterm delivery. Images: googleimage.com; gabbeobstetrics.com. Objectives.
Describe physiology of initiation of labor Define normal and abnormal labor. Ovulation enhancement
has proceeded without formal guidelines, and advanced training and certification is not required for
its practice. Nutritient delivery as fluid into the gastrointestinal tract. Most authors have explained
this by noting that the timing of antibiotic treatment after preterm labor is clinically manifest is too
late to influence any outcomes other than acute neonatal or maternal infection. You can download
the paper by clicking the button above. Through routine exams, the doctor should be able to identify
certain risks factors in a timely manner, and then develop a course of action to manage them.
Second, the use of predictors of spontaneous preterm. Obstet Gynecol. 2016;127:190-191. 3. Martin
JA, Hamilton BE, Osterman MJ, et al. To browse Academia.edu and the wider internet faster and
more securely, please take a few seconds to upgrade your browser. This suggests three possibilities:
(1) that progesterone is effective in inhibiting a pathway shared by diverse causes of preterm birth,
(2) that progesterone has diverse effects that act on several different pathways, or. Inadequate supply
of oxygen to vital organs can prevent them from developing properly and can lead to chronic
diseases. Stavros Petrou of the University of Oxford, an appointed consultant, provided information
and assistance on the economic consequences of preterm birth. These drugs affect either the
contractile proteins (usually the phosphorylation of myosin) by generation or alteration of an
intracellular messenger or inhibit the synthesis or block the action of a known myometrial stimulant.
Twin pregnancies were reduced from 19 percent to 3 percent (Gordts et al., 2005).
Data showing that progesterone provides a benefit are available only for women with a prior preterm
birth at between 18 and 36 weeks of gestation. Also, you can type in a page number and press Enter
to go directly to that page in the book. Interrelation Between Periodontal Disease and Preterm Birth
By Fernando Oliveira Costa, Alcione Maria Soares Dutra Oliveira and Lui?s Ota?vio Miranda Cota
2,975 1 2. We wish to thank the following individuals for their review of this report. The National
Academy of Engineering was established in 1964, under the charter of the National Academy of
Sciences, as a parallel organization of outstanding engineers. Thus, over the past decade, the problem
of newborn survival has also begun to receive greater attention globally through an increased volume
of publications and meetings. The following considerations should be given to women in preterm
labor. Funds for the committee’s work were provided by the National Institute for Child Health and
Human Development, the Centers for Disease Control and Prevention, the Health Resources and
Services Administration, March of Dimes, Burroughs Wellcome Fund, American College of
Obstetricians and Gynecologists, Environmental Protection Agency, National Institutes of Health
Office of Research on Women’s Health, American Society for Reproductive Medicine, and the
Society for Maternal-Fetal Medicine. This approach has not decreased the incidence of preterm birth
but can delay delivery long enough to allow administration of antenatal steroids and to transfer the
mother and fetus to an appropriate hospital, two interventions that have consistently been shown to
reduce the rates of perinatal mortality and morbidity. Prematurity is an explicit public health priority
in many high-income countries. Southampton (UK): NIHR Journals Library; 2013 Sep. (Health
Technology Assessment, No. 17.40.) Available from. This goal is important, because the continuation
of preg nancy in women with preterm parturition in some instances may increase the health risk for
the mother or the fetus, or both. Finding 5-3: The mechanisms by which conditions of infertility,
subfertility, and fertility treatments increase the risk of preterm birth, particularly among singleton
pregnancies, are unknown. In 2003, for women under age 35, an average of 2.6 fresh nondonor eggs
were transferred per cycle (CDC, 2003d). This increase in survival has not yet been accompanied by
an apparent increase in major morbidity. COX-2 is the isoform whose levels dramatically increase in
the decidua and the myometrium during term and preterm labor. The authors appreciated inputs
from Sarah Alexander, Valentina Baltag, Venkatraman Chandra-Mouli, and Charlotte Christiansen,
Eve Lackritz, Elizabeth Mason, Jeff Murray, Craig Rubens, and Catherine Spong. A study by Klip
and colleagues (2000), in which a cohort of women in the Netherlands was monitored for 5 to 8
years, found no increase in the risk of breast cancer or ovarian cancer in women who underwent IVF
compared with that in subfertile women who had not undergone IVF. Of concern, that report
included data that suggested that antibiotic use might actually increase the likelihood of preterm
birth, a finding similar to the NICHD Network trial of metronidazole treatment for women infected
with Trichomonas vaginalis (Klebanoff et al., 2001). Although the data from these two studies are
preliminary, they argue against the clinical use of antibiotics solely to prevent preterm birth until
future research explains these findings. Tocolytic drugs, which are used to arrest labor, can have
serious maternal and fetal side effects, especially if they are used in increasing doses, for prolonged
periods, or in combination with one another. Inadequate supply of oxygen to vital organs can prevent
them from developing properly and can lead to chronic diseases. These could include, for example,
studies of social interventions in women with measurable evidence of stress and studies of activity
restriction in women with short cervical lengths. Through routine exams, the doctor should be able to
identify certain risks factors in a timely manner, and then develop a course of action to manage them.
Also, you can type in a page number and press Enter to go directly to that page in the book. Fetal
fibronectin in cervical and vaginal secretions as a predictor of preterm delivery. Not only is there a
paucity of welldesigned and adequately powered clinical trials, but there is incomplete understanding
of the sequence and timing of events that precede clinical evidence of preterm labor. Funding
supports the capabilities of PQCs to improve the quality of perinatal care in their states, including
efforts to reduce preterm birth. However, there has been relatively little attention from the public and
research community despite the significant impact preterm birth and prematurity have on infant
mortality and subsequent disabilities of many survivors, and on societal and economic costs to the
nation. Preterm infants are at greater risk for short and long term complications. You can also focus
your essay entirely on those matters.
Washington (DC): National Academies Press (US); 2007. Ultrasound, the current gold standard, is
not always affordable in low-resource settings and does not predict spontaneous preterm birth, a
leading cause of infant death. Our Authors and Editors We are a community of more than 103,000
authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners
and some of the world’s most-cited researchers. JULIANA BENAVIDES GUERRERO
Epidemiological Study Design, Research Design, Clinical Research Epidemiological Study Design,
Research Design, Clinical Research Dr KHALID B.M USG,CT AND MR IMAGING OF HEPATIC
MASS LESIONS. However, there are cases when doctors fail to meet their responsibilities, leading
to birth injuries. SLIT2-ROBO1 signaling was linked with regulation of genes involved in
inflammation, PSG genes, decidualization and fetal growth. The use of antenatal thyrotropin-
releasing hormone (TRH) to reduce neonatal lung disease has been studied in trials that enrolled more
than 4,600 women. A cervical length of 30 mm or more by endovaginal sonography, however,
suggests that preterm labor is unlikely in symptomatic women if the examination is properly
performed (Iams, 2003). The authors appreciated inputs from Sarah Alexander, Valentina Baltag,
Venkatraman Chandra-Mouli, and Charlotte Christiansen, Eve Lackritz, Elizabeth Mason, Jeff
Murray, Craig Rubens, and Catherine Spong. Start writing a plan in advance and don’t hesitate to
ask for help, if you are not sure you can handle this assignment on your own within the given time
frame. Obstet Gynecol. 2016;127:190-191. 3. Martin JA, Hamilton BE, Osterman MJ, et al. This is
suggested by reports that infants born after spontaneous preterm labor in the absence of apparent
maternal disease have a higher than expected rate of poor intrauterine growth (Bukowski et al.,
2001b; Gardosi, 2005). Naidoo Surviving prematurity poses the greatest challenge in neonatal care in
low- to middle-income countries (LMICs). Sign up for email notifications and we'll let you know
about new publications in your areas of interest when they're released. This section reviews clinical,
biophysical, and biochemical tests that can be used as predictors for preterm birth. Treatment has
been directed toward the inhibition of contractions. Southampton (UK): NIHR Journals Library;
2013 Sep. (Health Technology Assessment, No. 17.40.) Available from. Its causes may include
individual-level behavioral and psychosocial factors, sociodemographic and neighborhood
characteristics, environmental exposure, medical conditions, infertility treatments, and biological
factors. Fetal conditions, such as red cell alloimmunization or a twin-to-twin transfusion sequence,
might also progress to require indicated preterm birth in an effort to prevent stillbirth. The authors
concluded that a single dose of subcutaneous terbutaline was an efficient method of identifying
those with actual preterm labor. One large multicenter trial (Gamsu et al., 1989) found evidence of a
benefit for as long as 18 days after the initial course of treatment. Register for a free account to start
saving and receiving special member only perks. Special recognition is also given to Eli Adashi and
Gloria Sarto for the fundamental roles they played in the initiation of this activity. In the first section
of this book we present an update on the association of periodontal disease, maternal stress, and
activation of the hemostatic system and preterm parturition. Such engagement will serve to
accelerate progress towards all eight MDGs and have an effect beyond improving maternal, newborn
and child survival. This suggests three possibilities: (1) that progesterone is effective in inhibiting a
pathway shared by diverse causes of preterm birth, (2) that progesterone has diverse effects that act
on several different pathways, or. HMGB1 spatial localization was evaluated by immuofluorescent
staining (IF). Edited by: Howson C, Merialdi M, Lawn J, Requejo J, Say L. 2009, White Plains, NY:
March of Dimes. In recent years, an unintended consequence of the use of these technologies,
multiple gestations and the increased risk for preterm delivery, has become a focus of attention.
Concern has been raised about the use of ICSI (see section below on Maternal and Child Risks).
Best regards. I recommend this publication for the following reasons Loading. South Africa has not
made much progress in improving the survival of preterm babies. Health Policy Plan. 2005, 20 (Suppl
1): i49-i57. Article. Transfer of an additional embryo is suggested if an unfavorable prognosis exists.
Corticosteroid Therapy to Enhance Fetal Lung Maturation. Because preterm labor or premature
rupture of membranes may occur in response to conditions that threaten fetal or maternal well-being,
whether preterm birth is appropriately preventable is a topic that regularly influences clinical decision
making. Second, the use of predictors of spontaneous preterm. A recent study examined the results
of approximately 200 IVF cycles in which patients had either one or two embryos transferred. Figure
5-1 depicts the frequency with which procedures involving ARTs were used in the United States in
2003. These same maternal medical illnesses also increase the risk of preeclampsia and, thus, the risk
of indicated preterm birth. It is likely that all of these factors are operative to various degrees in an
individual, but to date there is no satisfactory method to determine the contributions of physical and
biochemical influences on the cervix and, thus, no way to select an appropriate therapy. Register for
a free account to start saving and receiving special member only perks. For example, a distinction
should be made between triplet live births and the percent of triplets detected with heart beats since a
discordance may exists as a consequence of the use of multifetal reduction. Dr. Wm. A. Wulf is
president of the National Academy of Engineering. In recent years, an unintended consequence of
the use of these technologies, multiple gestations and the increased risk for preterm delivery, has
become a focus of attention. You can download the paper by clicking the button above. Targeting
single conditions or interventions is unlikely to substantially reduce stil. Because oxytocin receptors
are mostly confined to the uterus and myoepithelial cells of the breast, maternal side effects are
minimal (Romero et al., 2000). Oxytocin antagonists cross the placenta, but fetal cardiovascular
status and acid-base status are not affected. Many of these factors co-occur, particularly in those who
are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. This
boundary varies internationally, however, from about 20 to 24 weeks. Gestational Age Management
by the American College of Obstetricians and Gynecologists. Institutions and companies, registered
as VAT taxable entities in their own EU member state, will not pay VAT by providing IntechOpen
with their VAT registration number. Any opinions, findings, conclusions, or recommendations
expressed in this publication are those of the authors and do not necessarily reflect the view of the
organizations or agencies that provided support for this project. Although some payers underwrite
ovulation enhancement, most do not underwrite IVF, the outcome of which is more predictable than
that of ovulation enhancement and which results in a lower rate of multiple births. Meta-analyses
address the issue of sample size but do not overcome problems with poor study design, selection
criteria, and the use of intermediate outcomes. Use of the markers in concert improved the predictive
ability. An alternative, generally in adults, is a surgical tube placed directly through the skin into the
stomach or intestine (gastrostomy or jejunostomy). Download Free PDF View PDF See Full PDF
Download PDF Loading Preview Sorry, preview is currently unavailable. Click here to buy this book
in print or download it as a free PDF, if available. To date, no single test or sequence of tests has an
optimal sensitivity or predictive value.
Natl Vital Stat Rep. 2015;64:1-65. 4. Effect of corticosteroids for fetal maturation on perinatal
outcomes. They performed a nested case-control study with a cohort of 2,929 women with singleton
gestations recruited from the general obstetric populations of the 10 participating centers
(Goldenberg et al., 2001). The women in that study underwent serial assessment of serum, cervical,
vaginal, ultrasound, and historical markers or risk factors. The mechanism(s) that place a woman at
increased risk for preeclampsia are unknown. Interventions to strengthen preterm birth prevention
and care span the continuum of care for reproductive, maternal, newborn and child health. Conflict
of interest The authors declare that they have no competing interests. A study of periodontal
screening and treatment in pregnant women to reduce the rate of preterm birth (Jeffcoat et al., 2003)
enrolled 366 women who were randomized at 21 to 25 weeks of gestation to one of three treatment
groups: routine dental care plus placebo medica-. Non-college educated women were more likely to
experience problems with infertility and impaired fecundity than women with 4-year college
degrees. It is autonomous in its administration and in the selection of its members, sharing with the
National Academy of Sciences the responsibility for advising the federal government. A single report
has suggested that the magnitude and the significance of a short interpregnancy interval are the
greatest when the index pregnancy was a preterm birth rather than a term birth (Hsieh et al., 2005).
In 2003, 48,756 infants were born as a result of the use of ARTs, whereas 20,840 were born in 1996.
This book addresses the need for research involving clinical, basic, behavioral, and social science
disciplines. Based on feedback from you, our users, we've made some improvements that make it
easier than ever to read thousands of publications on our website. Register for a free account to start
saving and receiving special member only perks. The risks are even greater for higherorder multiple
births. Donald Mattison, Scott Grosse, and Samuel Posner, who served as project officers and who
were instrumental in the initiation of this activity. Figure 9-1 shows the negative skew in birth
weights for fetuses destined for preterm birth versus the range of fetal weights of fetuses ultimately
born at term. Preterm birth is a cluster of problems with a set of overlapping factors of influence.
Margaret Comerford Freda, EdD, RN, CHES, FAAN Ellen Tate Patterson, DNS, RN. Fetal
fibronectin in cervical and vaginal secretions as a predictor of preterm delivery. GERIATRIC
PHARMACOLOGY Geriatric pharmacology is a specialized field focusing. Some investigators have
speculated about the effects of fertility drugs on the risk of breast cancer and cancers of the
reproductive system. HMGB1, RAGE protein levels were assessed by western blot assay. Concern
has been raised about the use of intracytoplasmic sperm injection, as this procedure impedes the
ovum’s natural ability to resist fertilization by a sperm that would otherwise not have the ability to
fertilize the egg. Evaluation of the Pregnancy Medical Home risk screen provides insight to increase
its sensitivity and specificity to improve identification of women early in pregnancy at highest risk
for preterm birth. A study by Klip and colleagues (2000), in which a cohort of women in the
Netherlands was monitored for 5 to 8 years, found no increase in the risk of breast cancer or ovarian
cancer in women who underwent IVF compared with that in subfertile women who had not
undergone IVF. You may be even surprised yourself on how things have changed since then. Stavros
Petrou of the University of Oxford, an appointed consultant, provided information and assistance on
the economic consequences of preterm birth. Respiratory morbidity in late preterm births. JAMA.
2010;304:419-425. 9. Stutchfield P, Whitaker R, Russell I. The ensuing decrease in intracellular free
calcium levels leads to inhibition of calcium-dependent myosin light-chain kinase phosphorylation
and results in myometrial relaxation. Approximately 2.1 million of these women, or 7 percent of all
women between the ages of 15 and 44, were infertile, defined as not becoming pregnant after 12
months when the couple is not using contraception (CDC, 2002b).
Stillbirth prevention requires recognition of maternal conditions, and care in a facility where fetal
monitoring and expeditious delivery are possible, usually by cesarean section. The chapter also
provides an overview of infertility treatments and the resulting risk of multiple gestations, which
place women at a greater risk for preterm delivery. Rasmussen and colleagues (2001) examined more
than 250,000 infants with known gestational ages born between 1989 and 1995 in the Atlanta,
Georgia, metropolitan area. ESHRE guidelines on the recommended number of embryos to be
transferred emphasize the elective transfer of a single embryo for women up to 36 years of age if at
least one good-quality embryo has been produced. The National Institute of Child health and Human
Development Maternal-Fetal Medicine Units Network. A study that compared ampicillin plus
erythromycin and placebo (Mercer et al., 1997) demonstrated improved neonatal outcomes (risk of
death, respiratory distress syndrome, sepsis, severe intraventricular hemorrhage, and severe
necrotizing enterocolitis) in the infants of women receiving antibiotics compared with the neonatal
outcomes in women receiving placebo. Second, the use of predictors of spontaneous preterm. The
purpose of tocolytic agents is to inhibit myometrial contractions. Functional or structural maternal
cardiac disease is an example of one such illness. The number of weeks of completed gestation that
defines whether a birth is preterm rather than a fetal loss has become smaller. If a doctor fails to
meet any of these responsibilities, it can result in birth injuries and he or she may be held liable.
Table 9-4 summarizes the myriad efforts used to identify the risk of preterm birth based on
biomarkers from asymptomatic women (Vogel et al., 2005). Dr. Wm. A. Wulf is president of the
National Academy of Engineering. This study updates all existing evidence on this topic and reviews
evidence on interventions that have not been previously considered in current WHO
recommendations. January 2005 to December 2008 a total of 6826 babies were admitted. Neonatal
mortality and morbidity rates in late preterm births compared with births at term. Although that topic
could change into a whole finance dissertation. The authors reported that infertility was more
common for Hispanic, non-Hispanic black, and non-Hispanic women of other races than for non-
Hispanic white women. Thus, despite several interventions designed to inhibit preterm labor and
prolong pregnancy, the frequency of preterm birth continues to pose a major barrier to the health of
newborns worldwide. Preterm birth is critical for progress on Millennium Development Goal 4
(MDG) for child survival by 2015 and beyond, and gives added value to maternal health (MDG 5)
investments also linking to non-communicable diseases. You can download the paper by clicking the
button above. In addition, they can increase the risk of preeclampsia and, thus, the risk of indicated
preterm birth. The risks are even greater for higherorder multiple births. Artigas Complejo Barrail -
Calle 4 Edificio Rosa T - 3er. Concern about the quality in apparently normal survivors has been
increasing as well. A study from the First And Second Trimester Evaluation of Risk trial examined
whether the use of ART was associated with an increased risk of chromosomal abnormalities, fetal
malformations, or adverse pregnancy outcomes among singleton births (Shevell et al., 2005).
Approximately 95 percent of patients did not use any form of ART, 3.4 percent used ovulation
induction, and 1.5 percent received IVF treatment. NIH Consens Statement. 1994;12:1-24. 5.
Society for Maternal-Fetal Medicine (SMFM) Publications Committee. The betamethasone group
had two neonatal deaths: one from septic shock, and the other from a structural cardiac anomaly and
arrhythmia. Much less attention has been paid to the role of ovulation promotion (superovulation or
intrauterine insemination and conventional ovulation induction), which is equally important in terms
of its contribution to multiple gestations. Data was extracted using inclusion and exclusion criteria,
study site and facilities, assessment methods and outcomes of mortality, morbidity, growth and
development.