Analysis of Delivery in Singleton Pregnancies Achieved by In Vitro Fertilization

Singleton pregnancy using in vitro fertilization or intracytoplasmic sperm injection does not increase risk of bleeding in cesarean delivery: a retrospective cohort study

PURPOSE

Several studies indicate that assisted reproductive technology (ART) including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies carries increased risk of complications including postpartum hemorrhage (PPH). However, the association between IVF/ICSI and the bleeding risk particularly in cesarean delivery has not been systematically assessed. The aim of this study was to evaluate bleeding risk during and after cesarean delivery in parturients who conceived using IVF or ICSI.

METHODS

This is a retrospective observational study analyzing data from 310 parturients who underwent cesarean delivery: 155 who had conceived using IVF or ICSI (IVF/ICSI group) and 155 age and year of delivery matched controls who had conceived spontaneously (control group). The primary outcome measure was the amount of blood lost during and within 24 h after cesarean delivery. Secondary outcome measure was the incidence of severe PPH. With 132 parturients in each group, we had 90% power to detect a 200 mL difference in the bleeding amount, at a 0.05 two-sided significance level.

RESULTS

The amount of bleeding in the IVF/ICSI group was 1234 ± 669 mL, which was 124 mL (11.2%) greater than that in the control group (95% CI - 34 to 282; p = 0.12). The incidence of severe PPH in the IVF/ICSI group and in the control group was 23.9% and 16.8%, respectively (p = 0.16), and the unadjusted odds ratio was 1.6 (95% CI, 0.9-2.7; p = 0.12). No significant independent effect of IVF/ICSI on the bleeding amount and the incidence of severe PPH was observed in multivariable regression analyses (p = 0.22, p = 0.16).

CONCLUSION

In this study, IVF and ICSI were not associated with increasing risk of bleeding in cesarean delivery.

Obstetric Outcomes and Successful Reduction of Twin Pregnancies Achieved by In Vitro Fertilization

The use of in vitro fertilization methods around the world is constantly increasing. In some developed countries, up to 5% of newborns are as a result of pregnancies after IVF procedures. In vitro fertilization as one of the main and widespread methods for treatment of infertility is the main reason for the high frequency of multiple pregnancies, which, in many countries, is still too high. Most of the multiple pregnancies are in fact twin pregnancies. Twin pregnancies, regardless of how they are achieved, are associated with large number of complications compared with singleton ones. More often these pregnancies can lead to maternal complications and adverse pregnancy outcomes. Maternal complications include development of preeclampsia, gestational diabetes, placenta previa, placental abruption, premature rupture of membranes, antepartum and postpartum hemorrhage, and delivery by cesarean sections. Adverse pregnancy outcomes mostly include preterm birth (PTB), low birth weight (LBW), small for gestational age newborn (SGA), intrauterine growth restriction (IUGR), neonatal respiratory distress syndrome (RDS), and admission to neonatal intensive care unit (NICU). A number of studies have found differences in the course of twin pregnancies according to their mode of occurrence – spontaneous or after IVF. Some of them have found that twin pregnancies after IVF are associated with poorer obstetric and perinatal outcomes, others do not find such a difference, and there are even studies that find a better outcome in IVF twin pregnancies. Twin pregnancy is a common occurrence after IVF procedure, because multiple-embryo transfer is commonly regarded as an effective strategy to improve the likelihood of a successful pregnancy. Understanding the risks of these pregnancies should be a strong motive for the transfer of fewer embryos during IVF procedures. The most effective way to do this is to transfer a single-embryo into the uterus in cases, where this is justified and the chances of getting pregnant are high. An important element in achieving this goal is the use of methods for vitrification of embryos, which leads to a sufficiently high rate of clinical pregnancies after freezing of embryos obtained by IVF and their subsequent transfer after thawing in case of failure of fresh ET.

A New Approach of Several Minimally Invasive Procedures for Improvement of the Outcome in Preterm Infants

BACKGROUND: Based on the last update of European Consensus Guidelines on Management of Respiratory Distress Syndrome, the following study is new for our clinic approach for minimally invasive respiratory support in preterm infants. AIM: The aim is to find out if the implementation of several minimally invasive procedures leads to a reduction of the frequency and severity of chronic complications and improved outcomes in extremely premature infants. MATERIALS AND METHODS: Infants are below 30 gestational weeks, divided into two groups – therapeutic – 37 infants on standardized early respiratory management protocol which includes: High-flow continuous positive airway pressure (20l/min ≥ 15 PEEP) in the delivery room, support of spontaneous breathing and non-invasive mechanical ventilation, avoidance of hypothermia and LISA shortly after birth, and control group – 46 infants that received standard respiratory support (positive pressure ventilation – invasive and non-invasive in the delivery room, most infants ≤ 27 weeks gestational age were intubated and received early surfactant, extubation “when being ready” – usually after few days). RESULTS: The duration of mechanical ventilation, oxygen therapy, and hospital stay is shorter in the therapeutic group (p < 0.05). Severe bronchopulmonary dysplasia is not found in the interventional group, 26% of the patients in the control group have severe form of the disease (p = 0.001). Severe intraventricular hemorrhages are found in 11% of the infants in the therapeutic group and 28% in the control group (p = 0.06). CONCLUSION: Due to the changed protocol, we report increased survival of ELBW infants without severe chronic complications. The acute pulmonary injury, acquired in the perinatal period, is directly connected with the development of BPD. For this reason, all the changes that we introduced in our clinic (heat management, support of spontaneous breathing, “open up” lungs – high flow PEEP/CPAP, and LISA during spontaneous breathing) contribute to the lower frequency of severe chronic complications and high percentage of ELBW infants, who do not develop severe BPD.