Biomedical subjects

P Koutra

Publications and source records attributed to P Koutra.

3 recordsLinked to original sources

PubMed2004

Embryo reduction versus expectant management in triplet pregnancies.

OBJECTIVE: In triplet pregnancies, to compare pregnancy outcome of expectant management with that after embryo reduction to twins. METHODS: Retrospective study of 255 trichorionic triplet pregnancies, of which 185 had embryo reduction to twins (reduced group) and 70 were managed expectantly (non-reduced group). RESULTS: Median birth weight was higher by about 500 g and gestation prolonged by about 3 weeks in the reduced pregnancies compared with the expectantly managed pregnancies (2300 vs. 1760 g; 36 vs. 33 weeks). The rates of preterm delivery were significantly lower in the reduced group (11.17 vs. 36.76% for delivery at < or = 32 weeks and 40.58 vs. 83.82% for delivery at < or = 35 weeks, reduced vs. non-reduced group). The percentage of infants born with low birth weight was significantly higher in the expectantly managed triplets (10.98 vs. 28.44% for birth weight < or = 1500 g and 68.55 vs. 92.89% for birth weight < or = 2500 g, reduced vs. non-reduced group). Total fetal loss was significantly higher in the reduced group than in the non-reduced group (15.41 and 4.76%, respectively) and the difference was mainly due to the higher miscarriage rate in the reduced group (8.11 vs. 2.86% in the non-reduced group). With the expected rates of handicap in preterm infants, we would anticipate 0.63% of severely handicapped children due to extreme prematurity in the reduced group and 1.64% in the non-reduced group. CONCLUSION: In triplet pregnancies, embryo reduction to twins significantly reduces the risk of severe preterm delivery and very low birth weight by about one-third, at the expense of a significant increase in total fetal loss, by about one-quarter. The procedure is likely to reduce the risk of having a severely handicapped child due to extreme prematurity.

Abortion, Spontaneous↗

PubMed2004

Pregnancy outcome after multifetal pregnancy reduction.

OBJECTIVE: To study the effects of multifetal pregnancy reduction (MFPR) as a means to reduce the adverse outcome of multiple gestations. METHODS: This was a retrospective study evaluating the outcome of 334 multiple pregnancies after embryo reduction. RESULTS: In 313 multiple pregnancies in which MFPR was performed before 15 weeks, the rates of miscarriage, preterm delivery <33 weeks, preterm delivery <36 weeks and total fetal loss were 9.12%, 13.33%, 38.60% and 16.25%, respectively, and median gestational age at delivery was 35 weeks. There was a significant correlation between miscarriage and the finishing number of fetuses. In 185 triplets reduced to twins, miscarriage, preterm delivery <33 weeks, preterm delivery <36 weeks and total fetal loss occurred in 8.25%, 11.18%, 40.59% and 15.41% of cases, respectively, and median gestational age at delivery was 36 weeks. In the subgroup of 32 reduced triplet pregnancies that also had second-trimester amniocentesis, the risk of miscarriage (3.13%) was not significantly different from that in the rest of the group. Among 21 twin pregnancies that had selective termination at or after 15 weeks, the risk of preterm delivery <33 weeks was three times higher than in the group of 22 twin pregnancies with first-trimester procedures. CONCLUSION: MFPR resulted in at least one live neonate in 83.75% of cases and was effective in reducing the risks of pregnancy loss and severe prematurity in quadruplets and higher-order pregnancies. The risk of miscarriage increased with increasing finishing number of fetuses. In reduced triplets gestation was prolonged in comparison with average figures reported in the literature. In twin pregnancies selective termination in the first trimester carries a lower risk of severe preterm delivery and this emphasizes the need for first-trimester diagnosis.

Abortion, Spontaneous↗

PubMed2001

First trimester transabdominal embryo fetoscopy.

The aim of this study was the visualization of the embryo and blood sampling through transabdominal embryoscopy during the first 12 week of pregnancy. Twenty women attending Alexandra Maternity Hospital, Athens for pregnancy termination were invited to participate in this study. Informed consent was obtained before participation. The gestational age ranged between 9 and 12 weeks from LMP. We used a Karl Storz semirigid fiberoptic endoscope 20 cm in length, with a diameter of 1 mm and an angle of view of 70 degrees. Under local anesthesia the endoscope was introduced transabdominally into the amniotic sac, using continuous ultrasound guidance. Complete examination of the embryo including head, face, limbs ventral and dorsal walls, genitalia, placenta, umbilical cord and yolk sac were performed. A 0,6 mm diameter puncture needle was inserted into the blood vessels of the chorionic plate or umbilical cord through the side arm of the canulla to obtain a small amount of blood. The complete anatomical survey was possible in all cases (100%). Access to the embryonic circulation was attempted in 14 cases. A small quantity of blood was obtained in 10 cases (71,4%). The average length of the procedure was 15 min. No maternal complications were recorded. D & C were performed 24 hours after the embryoscopy. Embryoscopy represent a diagnostic tool to confirm a diagnosis suspected through noninvasive means. Gaining access to the embryonic circulation when embryos are immunologically naïve will allow perhaps gene or cell therapy. Finally embryoscopy may be helpful to study the biology of embryonic development.

Embryo, Mammalian↗