Associate professor, MD, PhD
Mohammed Rohi Khalil
Department of Gynaecology and Obstetrics, Odense University Hospital
| Project management | ||
| Project status | Sampling ongoing | |
| Data collection dates | ||
| Start | 01.01.2007 | |
| End | 30.06.2019 | |
Graviditetsforløb af flerfoldsfødsler (GRAF-projektet)
Short summary
In dichorionic twin pregnancies, the Danish national guidelines recommend induction of labor (IOL) at 38 weeks gestation. This stems from heightened risks of cesarean section and perinatal death ssociated with later gestational ages. This procedure demonstrates a success rate of successful vaginal delivery well above 60%. However, there remains inadequate documentation regarding potential variances in outcomes between induction methods such as amniotomy, prostaglandins, and balloon catheter.
Rationale
There have been limited studies evaluating outcomes following different methods of IOL, such as primary amniotomy, cervical priming using prostaglandin preparations, and cervical dilatation through the use of double balloon catheters. Consequently, our objective was to address this knowledge gap.
Description of the cohort
The descriptive cohort included all multiple pregnancies referred to our gynecologic & obstetric department in Kolding, for examinations and later on a delivery. The women were followed from first contact, about week 8 until 28 days after their delivery. Simultaneously we recorded clinical information's about diseases in the pregnancy and the way of delivery inclusive the children or child or an early abort. Women with early abortions of different causes were recorded as well and followed analogously. For registration of all these data, Erling Andreasen MD had established a special database in Redcap at OPEN in Odense university Hospital under nr. OP-618, see below. The Study was approved by the Regional Scientific Ethical Committees for Southern Denmark, case number 18/53689.
Data and biological material
In our Redcap database we recorded the women's demography, treatment for infertility and the results of a first-trimesters scan at week 12 to confirm gestational age and chorionicity, along with prenatal diagnostics. Subsequently, a second scan occurred at week 20 to asses cervical length and screen for fetal malformations. From this stage dichorionic (DC) twins underwent monthly monitoring, including assessment of fetal biometry and weight. In cases of growth discordance, umbilical artery Doppler assessment was conducted. Monochorionic (MC) twins underwent similar monitoring every two weeks, focusing on amniotic fluid volume and the peak systolic velocity of the middle cerebral artery. Early abortions before week 22 were recorded with the type and the gestational age. Early premature deliveries between week 22 and 28 have significant obstetric challenges and were forwarded directly to Odense University Hospital, and after treatment these women were readmitted for ongoing monitoring in our department. Diseases during pregnancy were recorded together with the treatment, and the types of deliveries were recorded together with their gestational age. The neonatal outcome was described with genders, weight, and the estimated scan-weight together with Apgar 5 minutes, and Ph in umbilical artery, together with malformation in according to ICD-10 Codes. The need and stay in Neonatal Care Unit were recorded as well. In July 2024 the responsibility for Redcap was handed over to Mohammed Khalil, Associate Professor, MD & PhD, and Erling Andreasen retired MD, continues as associated member.