OBJECTIF: Évaluer si la prééclampsie (PE) récidivante présente un taux de prématurité (< 37 semaines de gestation) plus élevé qu'une première PE. Les critères de jugement secondaires étaient le retard de croissance intra-utérin (RCIU) et la morbidité maternelle. MÉTHODES: Il s'agit d'une étude rétrospective de cohorte conduite sur 383 femmes avec un diagnostic de prééclampsie et ayant accouché au CHU Sainte-Justine à Montréal (Canada) entre 2001 et 2011. Parmi elles, 128 ont développé une récidive de PE à la grossesse successive. RÉSULTATS: Chez les femmes récidivantes (n = 128), les taux de prématurité et de RCIU étaient similaires dans les 2 épisodes de PE, bien que plus atteintes d'hypertension chronique (p = 0.001) et de diabète gestationnel (p = 0.021) dans leur seconde PE. Comparativement aux femmes non récidivantes (n = 255), les récidivantes (n = 128) présentaient, à leur première PE, un profil clinique caractérisé par un taux élevé de PE sévère (p < 0.001), éclampsie et critères adverses (p = 0.007). Le risque relatif de récidive de PE chez une femme avec ce profil clinique à sa première PE a été évalué à 1, 60 (95%IC: 1, 17 – 2, 18). CONCLUSION: La récidive de PE est associée à des taux similairement élevés de prématurité et de RCIU comparativement à la première PE. Les femmes qui à leur première PE ont un profil clinique défini par prééclampsie sévère, éclampsie ou présence de critères adverses sont plus à risque de récidive de PE à la grossesse subséquente. Mots clés: prééclampsie, récidive, issues périnatales, prématurité / OBJECTIVE: To assess whether a recurrent preeclampsia compared to the preeclampsia that occurred at the first pregnancy was more at risk of preterm delivery at < 37 weeks of gestation. Secondary outcomes were intrauterine growth restriction (IUGR) and maternal morbidity. STUDY DESIGN: We conducted a retrospective cohort study including 383 women with preeclampsia who delivered at Sainte-Justine Hospital in Montreal (Canada) from 2001 to 2011. Among these, 128 women developed a recurrent preeclampsia in their subsequent pregnancy. RESULTS: Among women with a recurrent preeclampsia (n = 128), no significant differences were found in the rates of preterm delivery and IUGR between the first and the subsequent pregnancy. Women with a recurrent preeclampsia were more at risk of chronic hypertension (p = 0.001) and gestational diabetes (p = 0.02) in their second pregnancy. Furthermore, women with recurrent preeclampsia had, at their first pregnancy, a higher rate of severe preeclampsia (p < 0.001), eclampsia and adverse criteria (p = 0.007), than women who experienced a single preeclampsia (n = 255). The Relative Risk to experience a recurrent preeclampsia at the second pregnancy, if a woman had the above criteria at the first pregnancy, was 1.60 (95%CI 1.17 - 2.18). CONCLUSION: Recurrent preeclampsia was not associated with a higher rate of preterm delivery. Women who experienced a severe preeclampsia, an eclampsia or adverse criteria in a first pregnancy were more at risk to have a recurrent preeclampsia in the subsequent pregnancy. Key words: preeclampsia, recurrence, perinatal outcome, and preterm delivery

Introdução: Prematuridade é a principal causa de morbimortalidade perinatal. A aplicação de um instrumento que identifique o grupo de pacientes de risco para parto pré-termo (PPT) permitirá a aplicação de estratégias de prevenção e reduzirá essa complicação. Objetivos: validar a calculadora de risco para PPT espontâneo antes da 34ª semana de gestação, disponibilizada pela Fetal Medicine Foundation (FMF), em uma amostra de mulheres brasileiras. Métodos: Estudo retrospectivo, observacional que analisou 1325 gestantes admitidas para seguimento pré-natal. Variáveis maternas de interesse foram coletadas por meio da análise de questionários, prontuários e contato telefônico. Em seguida, os dados foram inseridos na calculadora para cálculo do risco de PPT. As gestantes foram divididas em dois grupos de acordo com a ocorrência de PPT antes da 34ª semana (Grupo 1) ou parto após 37 semanas de gestação (Grupo 2). Análise de regressão múltipla foi efetuada para avaliar os efeitos das variáveis estudadas sobre a ocorrência de parto pré-termo antes da 34ª semana e para a construção de um modelo de discriminação, que foi avaliado pelo índice c. Curva ROC foi utilizada para os cálculos de sensibilidade e especificidade e, com base nesses valores, do valor de corte acima do qual o risco de PPT antes de 34 semanas foi significativamente maior em nossa amostra de pacientes. Resultados: A prevalência de PPT espontâneo antes da 34ª semana foi de 1.3%. As variáveis que apresentaram diferenças significativas entre os Grupos 1 e 2 foram: tabagismo (p=0,0002), antecedente de prematuridade de prematuridade repetitiva entre 16 - 30 semanas sem parto prévios a termo e de prematuridade eletiva (p<0,0001 e p=0,0271, respectivamente) e risco calculado de PPT antes de 34 semana (1.32% X 0.78%, p<0,01). A regressão múltipla confirmou que o tabagismo e os antecedentes de PPT aumentaram o risco de PPT espontâneo em nossa amostra. Na avaliação do desempenho do teste índice para detectar PPT antes de 34 semanas, observou-se área sob a curva significante de 0.64 e o ponto de corte acima do qual o risco de PPT aumenta significativamente foi 0.7%. Conclusões: a calculadora de risco de PPT antes da 34ª semana da FMF é um bom instrumento para rastrear gestantes em nossa amostra populacional e o valor de corte acima do qual esse risco aumenta é 0.7%. / Introduction: Prematurity is the leading cause of perinatal morbidity and mortality. The use of an instrument to identify the group of patients at risk for preterm birth (PTB) will allow the implementation of prevention strategies, therefore reducing this complication. Objectives: To validate the calculator for assessment of risk for spontaneous delivery before 34 weeks of pregnancy, provided by the Fetal Medicine Foundation (FMF) for a group of Brazilian women. Methods: This retrospective and observational cohort study comprised 1,325 women undergoing routine antenatal care. Maternal variables were collected through the analysis of questionnaires, medical records and telephone calls. Then the data were inserted in the software to calculate the risk of PTB. The patients were divided in two groups according to the occurrence of PTB before 34 weeks (Group 1) or birth after 37 weeks of pregnancy (Group 2). Multilevel regression analysis was used to determine the effects of maternal characteristics on the occurrence of PTB before 34 weeks and to build a discrimination model which was evaluated by the index c. ROC curve was used to determine sensitivity and specificity, and the cutoff value above which it the risk of PTB before 34 weeks was significantly higher in our patient sample. Results: The prevalence of spontaneous PTB before 34 weeks was 1.3%. Variables that showed significant differences between groups 1 and 2 were: smoking (p=0.0002), history of repetitive PTB between 16-30 weeks without prior term and elective PTB (p<0.0001 and p=0.0271, respectively), and the risk of PTB before 34 week (1.32% vs. 0.78%, p<0.01). Multilevel regression analysis confirmed that smoking and history of PTB increased the risk of spontaneous PTB in our patient sample. On the assessment of performance index test to detect PPT before 34 weeks there was a significant area under the curve of 0.64 and the cutoff above which it the risk of PTB before 34 weeks was significantly higher was 0.7 %. Conclusions: the calculator for assessment of risk for spontaneous delivery before 34 weeks of pregnancy is a good tool for screening pregnant women in our population sample and the cutoff value above which it the risk increases is 0.7%.

Introdução: Prematuridade é a principal causa de morbimortalidade perinatal. A aplicação de um instrumento que identifique o grupo de pacientes de risco para parto pré-termo (PPT) permitirá a aplicação de estratégias de prevenção e reduzirá essa complicação. Objetivos: validar a calculadora de risco para PPT espontâneo antes da 34ª semana de gestação, disponibilizada pela Fetal Medicine Foundation (FMF), em uma amostra de mulheres brasileiras. Métodos: Estudo retrospectivo, observacional que analisou 1325 gestantes admitidas para seguimento pré-natal. Variáveis maternas de interesse foram coletadas por meio da análise de questionários, prontuários e contato telefônico. Em seguida, os dados foram inseridos na calculadora para cálculo do risco de PPT. As gestantes foram divididas em dois grupos de acordo com a ocorrência de PPT antes da 34ª semana (Grupo 1) ou parto após 37 semanas de gestação (Grupo 2). Análise de regressão múltipla foi efetuada para avaliar os efeitos das variáveis estudadas sobre a ocorrência de parto pré-termo antes da 34ª semana e para a construção de um modelo de discriminação, que foi avaliado pelo índice c. Curva ROC foi utilizada para os cálculos de sensibilidade e especificidade e, com base nesses valores, do valor de corte acima do qual o risco de PPT antes de 34 semanas foi significativamente maior em nossa amostra de pacientes. Resultados: A prevalência de PPT espontâneo antes da 34ª semana foi de 1.3%. As variáveis que apresentaram diferenças significativas entre os Grupos 1 e 2 foram: tabagismo (p=0,0002), antecedente de prematuridade de prematuridade repetitiva entre 16 - 30 semanas sem parto prévios a termo e de prematuridade eletiva (p<0,0001 e p=0,0271, respectivamente) e risco calculado de PPT antes de 34 semana (1.32% X 0.78%, p<0,01). A regressão múltipla confirmou que o tabagismo e os antecedentes de PPT aumentaram o risco de PPT espontâneo em nossa amostra. Na avaliação do desempenho do teste índice para detectar PPT antes de 34 semanas, observou-se área sob a curva significante de 0.64 e o ponto de corte acima do qual o risco de PPT aumenta significativamente foi 0.7%. Conclusões: a calculadora de risco de PPT antes da 34ª semana da FMF é um bom instrumento para rastrear gestantes em nossa amostra populacional e o valor de corte acima do qual esse risco aumenta é 0.7%. / Introduction: Prematurity is the leading cause of perinatal morbidity and mortality. The use of an instrument to identify the group of patients at risk for preterm birth (PTB) will allow the implementation of prevention strategies, therefore reducing this complication. Objectives: To validate the calculator for assessment of risk for spontaneous delivery before 34 weeks of pregnancy, provided by the Fetal Medicine Foundation (FMF) for a group of Brazilian women. Methods: This retrospective and observational cohort study comprised 1,325 women undergoing routine antenatal care. Maternal variables were collected through the analysis of questionnaires, medical records and telephone calls. Then the data were inserted in the software to calculate the risk of PTB. The patients were divided in two groups according to the occurrence of PTB before 34 weeks (Group 1) or birth after 37 weeks of pregnancy (Group 2). Multilevel regression analysis was used to determine the effects of maternal characteristics on the occurrence of PTB before 34 weeks and to build a discrimination model which was evaluated by the index c. ROC curve was used to determine sensitivity and specificity, and the cutoff value above which it the risk of PTB before 34 weeks was significantly higher in our patient sample. Results: The prevalence of spontaneous PTB before 34 weeks was 1.3%. Variables that showed significant differences between groups 1 and 2 were: smoking (p=0.0002), history of repetitive PTB between 16-30 weeks without prior term and elective PTB (p<0.0001 and p=0.0271, respectively), and the risk of PTB before 34 week (1.32% vs. 0.78%, p<0.01). Multilevel regression analysis confirmed that smoking and history of PTB increased the risk of spontaneous PTB in our patient sample. On the assessment of performance index test to detect PPT before 34 weeks there was a significant area under the curve of 0.64 and the cutoff above which it the risk of PTB before 34 weeks was significantly higher was 0.7 %. Conclusions: the calculator for assessment of risk for spontaneous delivery before 34 weeks of pregnancy is a good tool for screening pregnant women in our population sample and the cutoff value above which it the risk increases is 0.7%.

In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposures and conditions. Consequently, attributing poor birth outcomes to prenatal alcohol exposure is a complicated and ongoing task, requiring continued attention to validated methodology and to identifying specific biological mechanisms.

[Truncated abstract] Veterinarians have considerable potential for exposure to several known reproductive hazards such as radiation, anaesthetic gases, pesticides, long working hours and occupational stress. Reproductive effects are a concern to female veterinarians, especially now that about 65% of graduates from Australian veterinary science schools are female. In the last two decades, there have been reports on the possible associations between occupational exposures and adverse reproductive outcomes in female veterinarians, but most of them have been equivocal and the whole area remains controversial. More evidence is needed before firm conclusions can be drawn. The Health Risks of Australian Veterinarians project (HRAV) was conducted as a questionnaire-based survey of all graduates from Australian veterinary schools during the 40-year period 1960-2000. Of 5,748 eligible veterinarians who were sent the questionnaires (73% of the whole cohort), 2,800 replied including 1,197 females (42.8%). Among women veterinarians eligible to participate, 59% participated . . . Identification of these associations may provide the opportunity for preventing harmful exposures and thus reduce the risk of any adverse reproductive outcomes not only for veterinarians, but also for other groups exposed to these risks such as veterinary nurses, animal laboratory technicians, anaesthetists, dentists, dental assistants, and other similar professional groups. The author of this thesis, having completely addressed the research objectives of her doctoral candidacy, has set out and acted on a future research agenda designed to explore the association between perceived occupational stress and pregnancy outcomes and infertility in Australian female veterinarians.

Die Malaria ist heute noch immer die bedeutendste parasitäre Infektionskrankheit des Menschen. Hiervon sind in Endemiegebieten neben Kleinkindern insbesondere schwangere Frauen betroffen. P. falciparum weist eine hohe genetische Diversität auf. So sind in Endemiegebieten Infektionen mit P. falciparum in der Regel polyklonal. Man spricht in diesen Fällen von der Multiplizität der Infektion. Bei Schwangeren sequestrieren mit P. falciparum infizierte Erythrozyten, die spezifische Oberflächenproteine exprimieren, in der Plazenta. Hierdurch bedingt können pathologische Schwangerschafts-verläufe klinische Manifestationsformen der Malaria darstellen. Um die Diversität von P. falciparum und die Multiplizität der Infektion bei schwangeren Frauen zu erforschen, wurden in einer Querschnittsstudie im holoendemischen Malariagebiet von Agogo in Ghana über den Zeitraum von einem Jahr 474 Gebärende mit einer nachgewiesenen plazentaren Infektion von P. falciparum untersucht. Hierzu wurden die Gene, die für das "Merozoiten-Oberflächen-Protein-1" (msp-1) und "Merozoiten-Oberflächen-Protein-2" (msp-2) kodieren, aus peripher und plazentar gewonnen Isolaten typisiert. Plazentar gewonnene Isolate waren im Vergleich zu peripher gewonnenen mit einer signifikant höheren Prävalenz an polyklonalen Infektionen und einer höheren Multiplizität der Infektion assoziiert. Die höchste Multiplizität der Infektion wurde bei Erstgebärenden und jüngeren Patientinnen beobachtet. Mit zunehmendem Alter und einer höheren Anzahl an vorangegangenen Schwangerschaften fielen signifikant sowohl die Multiplizität der Infektion als auch die Parasitendichte. Zudem wurde eine hohe Korrelation zwischen der Multiplizität der Infektion und der Parasitendichte nachgewiesen. Weder das Alter noch die Parität beeinflussten diese Korrelation. Der Einfluss von Alter und Parität auf die Multiplizität der Infektion konnte somit nicht unabhängig von der Parasitendichte nachgewiesen werden. Multivariate Analysen zeigten aber, dass es unabhängig von der Parasitendichte bei plazentaren Infektionen mit zwei und mehr als zwei Klonen im Vergleich zu monoklonalen plazentaren Infektionen mit einer höheren Wahrscheinlichkeit zu einer Frühgeburt kam. Dies betraf insbesondere Erstgebärende und Frauen mit submikroskopischen plazentaren Infektionen. Ob bei polyklonalen Infektionen eine Sequestration von P. falciparum in der Plazenta durch alle oder nur durch einen Teil der zahlreichen Genotypen geschieht, die an einer Infektion bei Schwangeren beteiligt sind, ist nicht entgültig geklärt. Es wurden aus zusammengehörenden plazentar und peripher gewonnenen P.-falciparum-Isolaten die Verteilungsmuster der Genotypen verglichen. Zwar korrelierte die Multiplizität der Infektion plazentarer und peripherer Isolate, die Genotypenmuster der Plazenta und der Peripherie waren jedoch deutlich unterschiedlich. Nur in 12% der Fälle konnte eine Genotypisierung eines peripher gewonnenen Isolates das klonale Gesamtbild der Infektion nachweisen. In 67% der Fälle waren neben identischen Genotypen wenigstens in einem der beiden Isolate unterschiedliche Genotypen nachweisbar. Einzelne spezifische Genotypen traten in der gesamten Untersuchungsgruppe öfter in der Plazenta als in der peripheren Blutprobe auf. Bei Frauen, die mit den Genotypen der Allelfamilie FC27 infiziert waren, lagen signifikant häufiger klinischen Manifestationen der Malaria vor. So konnte in multivariaten Analysen eine Assoziation zwischen FC27 und einer Frühgeburtlichkeit nachgewiesen werden. Darüber hinaus war FC27 zumindest in univariater Analyse mit einer Anämie und einem verminderten Geburtsgewicht assoziiert. Dies konnte insbesondere für Primiparae und für Gebärende mit submikroskopischen plazentaren Infektionen beobachtet werden. / Malaria is still one of the most considerable parasite infections of the human being. Pregnant women are at an increased risk in endemic areas. P. falciparum shows a high genetic diversity. In endemic areas infections with P. falciparum are very often polyclonal. They are described as multiple Infections or as the multiplicity of infection. In pregnant women P.-falciparum-infected-erythrocytes which exprimate specific surface proteins sequester in the placental tissue. Often this is the course of preterm delivery, low birth weight and anaemia. To investigate the diversity of P. falciparum and the multiplicity of infection in pregnant women a cross-sectional study was conducted in the holoendemic area of Agogo in Ghana. In this study over a period of one year 474 labouring women infected with placental P.-falciparum where investigated. To examine the diversity and the multiplicity of infection merozoite surface protein-1 (msp1) block 2 and merozoite surface protein-2 (msp2) genotypes were determined in Isolates from peripheral and placental blood samples. The study showed that in comparision to isolates of peripheral blood samples isolates of placental blood samples where associated with a significant higher prevalence of polyclonal infections and a higher multiplicity of infection. The highest multiplicity of infection was found among primiparae and young women. With age and parity multiplicity of infection as well as parasite density decreased. In addition a high correlation between the multiplicity of infection and parasite density could be demonstrated. Age and parity did not influence this correlation. Thus the influence of age independent from parity on the multiplicity of infection could not be proved. However, multivariate analyses showed, that independently from parasite density placental Infections with two or more clones were in comparison to monoclonal Infections associated with a higher probability of preterm delivery. This was the case especially in primiparae and in women with submicroscopical placental Infection. Presently it is not clear, whether all or only a subset of co-infecting genotypes sequester in the placental tissue. To address this issue the genotype distribution of matched placental and peripheral P. falciparum isolates where investigated. While the multiplicity of infection of placental and peripheral isolates correlated the genotype pattern of the placenta and the periphery differed extensively. Only 12% genotyping of a peripheral Isolate showed the entire picture of the infection. In 67% of the cases despite finding identical genotypes differing genotypes in at least one of the two Isolates were detectable. Specific genotypes appeared more often in the placental than in the peripheral Isolate. In women, who were infected with genotypes of the allelic family FC27 clinical manifestation of malaria were observed more often. In multivariate analysis an association between FC27 and a preterm delivery was established. Beside this at least in univariate analyses FC27 was associated with low birth weight and anaemia. This was the case especially for primiparae and labouring women with submicroscopic placental infections.

<p>Uvod: Vi&scaron;eplodne trudnoće se javljaju u 1,5% svih trudnoća nakon spontane koncepcije, dok nakon postupaka vantelesne oplodnje ovaj postotak u Evropi iznosi preko 20% uz velike varijacije među zemljama. U na&scaron;oj sredini, stopa vi&scaron;eplodnih trudnoća nakon postupaka vantelesne oplodnje iznosi daleko iznad 30%. Pojava hipertenzivnog sindroma u trudnoći, gestacijskog dijabetesa, operativnog zavr&scaron;avanja trudnoće, prevremenog porođaja, male porođajne telesne mase, neurolo&scaron;kih sekvela kod rođene dece i gotovo svih drugih komplikacija po majku i plod, kao i celokupno opterećenje zdravstvenog sistema vi&scaron;estruko su veći kod vi&scaron;eplodnih u odnosu na jednoplodne trudnoće i udeo navednih komplikacija raste sa brojem plodova. Sa druge strane deca iz postupaka vantelesne oplodnje čine i do 4,5% sve živorođene dece u pojedinim zemljama, &scaron;to uz činjenicu da infertilitet pogađa 16-18% parova u na&scaron;oj sredini daje ovoj pojavi posebnu dimenziju i činije i dru&scaron;tvenim problemom. Perinatalni ishodi trudnoća iz postupaka vantelesne oplodnje su u velikoj meri kompromitovani visokom stopom multiplih trudnoća, koje se danas smatraju komplikacijom, a ne uspehom postupaka vantelesne oplodnje. Jednoplodne trudnoće iz postupaka vantelesne oplodnje u većim studijama pokazuju diskretno slabije perinatalne ishode u odnosu na one spontano začete, dok kod vi&scaron;eplodnih trudnoća ova korelacija nije jasno izražena i dokumentovana, uz prisutnu dilemu da li je vi&scaron;eplodnost sama po sebi ili način koncepcije glavni problem u zapaženoj pojavi. Cilj rada: Uporediti perinatalne ishode vi&scaron;eplodnih trudnoća nastalih postupcima vantelesne oplodnje i spontano začetih kao i perinatalne ishode jednoplodnih i vi&scaron;eplodnih trudnoća iz postupaka vantelesne oplodnje. Pored navdenog cilj rada je i ukazati sveobuhvatnost navedenog problema i na moguća re&scaron;enja za smanjenje njihove učestalosti. Materijal i metode: Kombinacijom retrospektivne opservacione studije i prospektivne longitudinalne kohortne studije u periodu analizom perinatalnih ishoda pacijentkinja porođenih na Klinici za ginekologiju i aku&scaron;erstvo Kliničkog centra Vojvodine u periodu od od 01.01.2008. do 31.12.2010. godine, studija je analizirala i poredila perinatalne ishode kod 174 spontano začete vi&scaron;eplodne trudnoće, 163 vi&scaron;eplodne trudnoće nastale postupkom vantelesne oplodnje, kao i 155 jednoplodnih trudnoća začete postupkom vantelesne oplodnje. Analizirani parametric bili su telesna masa novorođenčeta, dostignuta gestacijska starost, vrednosti Apgar skora, učestalost hipertenzivnog sindroma kod majke i brojni drugi parametri perinatalnog ishoda. Uzeti od strane obučenih kliničara i uno&scaron;eni u posebno dizajniranu bazu podataka, rezultati su statistički analizirani u program JMP ver 9.0 (SAS publisher) uz kori&scaron;ćenje ANOVA analize za testiranje statističke značajnosti između srednjih vrednosti kontinuiranih varijabli, dok je statistička značajnost razlike učestalosti kategorijskih varijabli je određivana Pearsonovim &chi;2 testom. Rezultati: Jednoplodne ART trudnoće uz prosečnu starost od 33,5 godine, prosečnu gestacijsku starost na porođaju od 38,26 gn, udeo prevremenih porođaja od 12,9%, prosečnu telesnu masu od 3258 g, AS u prvom minutu od 8,35 i u petom minutu od 9,2, stopu carskog reza od 65,81%, udeo GDM-a od 7,1%, anemije od 41,94% i preeklampsije od 4,52%, ima sve relevantne parametre perinatalnog ishoda statistički značajno (p&lt;0.0001) superiornije od kako ART tako i non ART blizanačkih trudnoća. ART blizanačke trudnoće pokazale su prosečnu starost majke od 32,9 godina, prosečnu gestacijsku starost na porođaju od 35,6 gn, udeo prevremenih porođaja od 58,27%, prosečnu telesnu masu od 2374 g, AS u prvom minutu od 7,45 i u petom minutu od 8,65, stopu carskog reza od 83,7%, udeo GDM-a od 15,11%, anemije od 78,42% i preeklampsije od 12,23%, dok su non ART blizanačke trudnoće pokazale prosečnu starost majke od 28,8 godina, prosečnu gestacijsku starost na porođaju od 36,08 gn, udeo prevremenih porođaja od 49,71%, prosečnu telesnu masu od 2433 g, AS u prvom minutu od 7,75 i u petom minutu od 8,75, stopu carskog reza od 58,33%, udeo GDM-a od 7,02%, anemije od 67,84% i preeklampsije od 11,11%. Pored godina majke i udela carskog reza koji su bili vi&scaron;i u ART blizanačkim trudnoćama (&lt;0.0001), kao i blago veće pojavi poremećaja količine plodove vode (p=0,033), gotovo svi ostali pokazatelji toka i ishoda trudnoće bili su komparabilni u navedenim grupama. Diskusija i zaključak: Studija je pokazala da su tok i ishod vi&scaron;eplodnih trudnoća nastalih spontano i postupcima vantelesne oplodnje ekvivalentni u gotovo svim pokazateljima uz sličnu prosečnu telesnu masu i gestacijsku starost novorođenčadi, kao i da su svi navedeni parametri ovih vi&scaron;eplodnih trudnoća bez obzira na način koncepcije upadljivo i podjednako lo&scaron;iji u poređenju sa jednoplodnim trudnoćama iz postupka vantelesne oplodnje. Izuzimajući vi&scaron;eplodnost kao factor rizika deca iz postupaka vantelesne oplodnje su generalno zdrava. Sama vi&scaron;eplodnost, a ne način koncepcije predstavljaju problem, koje se sa pravom smatra najvećom komplikacijom vantelesne oplodnje. Dodatna analiza iskustava drugih zdravstvenih sistema ukazuje da jedino &scaron;iroka i sveobuhvatna implementacija strategije vraćanja samo jednog embriona (Single embryo transfer &ndash; SET) može da dovede do smanjivanje stope multiplih trudnoća nakon postupaka vantelesne oplodnje, i sledstvenih komplikacija, a bez ugrožavanja samog uspeha vantelesne oplodnje. Iskustva drugih zdravstvenih sistema ukazuju da je uspe&scaron;na implementacija SET-a jedino moguća uz angažovanje celog dru&scaron;tva, zajedno sa brojnim legislativnim merama iz domena nadzora, kontrole i finansiranja postupaka vantelesne oplodnje. Obim i način finansiranja postupaka vantelesne oplodnje od strane države (uz vi&scaron;e besplatnih poku&scaron;aja za infertilne parove) uz obaveznu upotrebu SET-a, i sistema krioprezervacije na osnovu primera iz prakse predstavlja ključ u borbi za smanjenje problema vi&scaron;eplodnih trudnoća nakon postupaka vantelesne oplodnje.</p> / <p>Introduction: Multiple pregnancies occur in 1.5% of all pregnancies after spontaneous conception and in more than 20 % of all pregnancies concieved after assisted reproductive technologies in Europe, with large variations between countries. In our setting, the rate of multiple pregnancies after the ART is well above 30%. The occurrence of hypertensive syndrome in pregnancy, gestational diabetes, operative delivery, premature birth, low birth weight, neurological and developmental impairment in children, and almost all the other complications for the mother and fetus, as well as the entire burden of the health system are several times higher in multiple pregnancies compared with singleton pregnancies. Incidence of&nbsp; forementioned complications rises with number of fetuses. On the other hand, children from in vitro fertilization procedures make up 4.5% of all live births in some countries, which together with the fact that infertility affects aproximately 16-18% of couples in our country gives an extra dimension to this phenomenon and makes it not just medical but wider social problem. Perinatal outcomes of pregnancies after assisted reproductive technologies (ART) are greatly compromised by the high rate of multiple pregnancies, which are now considered to be a complication rather than success of ART procedures. ART Singleton pregnancies have, in larger studies, show discretely lower perinatal outcomes compared with those conceived spontaneously, while for the multiple pregnancies, this correlation is not clearly expressed and documented. There remains dilemma whether multiplicity itself or the way of conception (ART vs. non ART) constitutes a major problem in the observed differences regarding perinatal outcome of ART pregnancies. Objective: To compare the perinatal outcomes of multiple pregnancies conceived by In vitro fertilization (IVF) and spontaneously and perinatal outcomes of IVF conceived singleton and multiple pregnancies. Additional aim of this thesis is to point out the complexity of this problem and offer possible solutions. Materials and Methods: Design of a study was a combination of retrospective and prospective observational longitudinal cohort study. Analysis included pregnancies which had delivery at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in the period from 1.01.2008. to 31.12.2010. The study analyzed and compared the perinatal outcomes in 174 spontaneous conceived multiple pregnancies, 163 multiple pregnancies resulting from IVF procedures, and 155 singleton pregnancies conceived by IVF procedure. Analyzed parameters were newborns birth weight, gestational age at delivery, the value of the Apgar score, occurrence of hypertensive syndrome in pregnancy, gestational diabetes, as well as numerous parameters of perinatal outcome. Taken by trained clinicians and were entered into a specially designed database, the results were statistically analyzed in JMP ver 9.0 software (SAS publisher) using ANOVA analysis to test the statistical significance between the mean values of continuous variables, while the statistical significance of the difference in frequency of categorical variables was assessed by Pearsons &chi;2 test. Results: ART singleton pregnancies had an average mothers age of 33.5 years, the average gestational age at birth of 38.26 gestational weeks (gw), preterm delivery rate of 12.9%, average birth weight 3258 g, Apgar score (AS) in the first minute 8.35, and in the fifth minute 9.2, cesarean section rate 65.81%, Gestational diabetes (GDM) in 7.1% pregnancies, anemia occurred in 41.94% of pregnancies, while preeclampsia was observed in 4.52% of all pregnancies. All relevant parameters of perinatal outcome were significantly (p&lt;0.0001) superior to both ART and non-ART twin pregnancies. ART twin pregnancy showed the average mothers age of 32.9 years, the average gestational age at birth of 35.6 gw, the preterm delivery rate 58.27%, the average body weight newborns 2374 g, AS in the first minute of 7.45, and in the fifth minute of 8.65, the cesarean section rate of 83.7%, GDM in 15.11% of all pregnancies, anemia occurred in 78.42% and preeclampsia in 12.23% of pregnancies, while the non-ART twin pregnancy showed an average mothers age of 28.8 years, the average gestational age at birth of 36.08 gw, the preterm delivery rate of 49.71%, the average body weight of 2433 g, AS in the first minute of 7.75 in the fifth minute 8.75, the caesarian section rate of 58.33%, GDM-a occurred in 7.02%, anemia in 67.84% and preeclampsia in 11.11% of pregnancies. Except for maternal age and the caesarean section rate, which were significantly higher in ART twin pregnancies (p&lt;0.0001), as well as small increase in proportion of amniotic fluid volume disorders (p = 0.033), almost all other parameters of perinatal outcome of were comparable in these groups. Discussion and Conclusion: The study showed that the course and outcome of multiple pregnancies conceived spontaneous and after IVF procedures are equivalent in almost all parameters with similar average body weight and gestational age at birth, and that all these parameters of multiple pregnancies regardless of the conception mode are equally worse compared with singleton pregnancies from IVF procedures. With the exception of multiplicity as a risk factor children from in vitro fertilization procedures are generally healthy. Multiplicity itself and not the mode of conception presented a problem, which is rightly considered the major complication of IVF today. Additional analysis of the experiences of other health system indicates that only a broad and comprehensive implementation of strategy to return only one embryo (SET&ndash;single embryo transfer) can lead to a reduction of the rate of multiple pregnancies after IVF procedures, and the accompanying complications, without compromising IVF success. The experience of other health systems indicate that a successful implementation of SET is only possible with the involvement of the whole society, along with a number of legislative measures in the field of monitoring, control and reimbursement of assisted reproduction procedures. The scope and funding of an IVF procedures (with more free attempts for infertile couples, reimbursed by public health) with mandatory use of SET, and good cryopreservation programs are, based on examples in other countries who had successfully dealt with his problem, is the key in reducing the problem of multiple pregnancies after IVF procedures.</p>