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Mandourah S, Badeghiesh A, Baghlaf H, Dahan MH. How does the need for IVF affect pregnancy complications among multiple gestations? The study of a large American population database including almost 100,000 multiple gestations. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100270. [PMID: 38125711 PMCID: PMC10733110 DOI: 10.1016/j.eurox.2023.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/25/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Objective This study's aim is to compare pregnancy outcomes in multifetal gestations that were conceived spontaneously compared to in vitro fertilization (IVF). Few population-based studies have addressed this topic. Study design This is a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database. Our study cohort included 90,552 multifetal gestations conceived spontaneously and 3219 IVF conceptions, from 2008 to 2014, inclusively. Multivariate logistic regression analyses were performed comparing maternal and neonatal outcomes, whilst adjusting for confounding variables. Subject was conducted using ICD-9 codes for multifetal gestation: 651. X and 76.1 and ICD-9 code for IVF: 23.85. Each pregnancy was included once. Results and conclusion IVF multifetal gestations had increased risk of pregnancy-induced hypertension (aOR 1.31, 95 % CI 1.20-1.43), gestational hypertension (aOR 1.21, 95 % CI 1.04-1.41), preeclampsia (aOR 1.31, 95 % CI 1.19-1.45), gestational diabetes (aOR 1.26, 95 % CI 1.13-1.41) and placenta previa (aOR 1.7, 95 % CI 1.32-2.19). IVF delivery outcomes were more likely complicated by cesarean section (aOR 1.21, 95 % CI 1.10-1.33), preterm premature rupture of membranes (aOR 1.33, 95 % CI 1.16-1.52), chorioamnionitis (aOR 1.71, 95 % CI 1.37-2.14), postpartum hemorrhage (aOR 1.44, 95 % CI 1.26-1.63) and transfusions (aOR 1.48, 95 %CI 1.26-1.74). IVF neonatal outcomes were more likely complicated by small for gestational age (aOR 1.26, 95 % CI 1.12-1.41) and congenital anomalies (aOR 1.82, 95 % CI 1.29-2.57). IVF was not found to increase risks of eclampsia, preterm delivery, operative vaginal delivery, hysterectomy, or intrauterine fetal demise.IVF increased the risk of pregnancy, delivery, and neonatal outcomes in multifetal pregnancies with risks increased from 20 % to 70 %. The role of infertility versus the need for IVF and the type of IVF protocol used should be further evaluated.
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Affiliation(s)
- Samar Mandourah
- Department of Obstetrics and Gynecology, McGill University, 1001 Decarie Boulevard, Montreal H4A 3J1, Quebec, Canada
| | - Ahmad Badeghiesh
- Department of Obstetrics and Gynecology, King Abdulaziz University, Rabigh Branch, Rabigh, Saudi Arabia
| | - Haitham Baghlaf
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | - Michael H. Dahan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Antoniou E, Orovou E, Iliadou M, Sarella A, Palaska E, Rigas N, Iatrakis G, Dagla M. The Kind of Conception Affects the Kind of Cesarean Delivery in Primiparous Women. Mater Sociomed 2021; 33:188-194. [PMID: 34759776 PMCID: PMC8565429 DOI: 10.5455/msm.2021.33.188-194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/18/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND So far, multiple factors have been found to be related to the IVF procedure, the most prevalent being extremes of maternal age, infections, previous gynecological history, infertility and others. Although women achieve the coveted pregnancy with the development of IVF technology, the rapid increase contributes to the increase of primary cesarean sections rates. OBJECTIVE The aim of the study was to identify if the kind of conception affects the kind of cesarean delivery among primiparous women in Greece. METHODS This cross-sectional observational study took place from September 2019 to February 2020 at the University Hospital of Larisa in Greece. One hundred and sixty-two primiparous women who underwent a cesarean section (c-section) after IVF (n=27) and natural conception (n=135) participated in the study. RESULTS The mean age of the IVF and natural conception groups were 36.22 and 31.08 years, respectively. Nineteen (70.4%) women of the IVF group had a previous medical or gynecological history in contrast to 48 (35.6%) women of the natural conception group. Only 55.6% of the IVF group had a full-term pregnancy unlike 88.1% of women in the natural conception group. An elective c-section was performed in 18 (66.7%) of the women who conceived after IVF, as opposed to 45 (33.3%) of the women who conceived naturally. CONCLUSION This cross-sectional study showed that IVF conception was associated with high rates of elective cesarean section as opposed to women with natural conception. The causes of c-sections must be evidence based because the primary cesarean delivery is a major factor contributing to increased c-section rates.
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Affiliation(s)
| | - Eirini Orovou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Angeliki Sarella
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Ermioni Palaska
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Nikolaos Rigas
- Department of Midwifery, University of West Attica, Athens, Greece
| | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Athens, Greece
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Antoniou E, Orovou E, Iliadou M, Sarella A, Palaska E, Sarantaki A, Iatrakis G, Dagla M. Factors Associated with the Type of Cesarean Section in Greece and Their Correlation with International Guidelines. Acta Inform Med 2021; 29:38-44. [PMID: 34012212 PMCID: PMC8116101 DOI: 10.5455/aim.2021.29.38-44] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cesarean section (CS) rates have been increasing worldwide with different effects on maternal and neonatal health. Factors responsible for the growing trend of CSs, include maternal characteristics, medical insurance and convenient scheduling or financial incentives. Effective interventions and guidelines are required to reduce CS rates. OBJECTIVE The aim of this research was to investigate the factors contributing to CS rate increase and their correlation with international guidelines. METHODS The performed analysis included the available socio-demographic and medical information retrieved from the medical records and a related questionnaire in both emergency and elective CSs. RESULTS Out of the included 633 births, the cesarean delivery rate was 58%. Women with a previous CS showed higher percentages for Elective CS (66.1%) compared to Emergency CSs for the same reasons (8.9%). Furthermore, 23% of the patients underwent an Emergency CS because of failure of labor to progress while 18% of CSs were due to maternal desire. CONCLUSION The high rates of CS in Greece demonstrate the lack of use of international obstetric protocols, national strategies, Cesarean Section audits and a significant shortage of midwives. A decrease in iatrogenic and non-iatrogenic factors leading to the primary CS will decrease CS rates.
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Affiliation(s)
| | - Eirini Orovou
- Department of Midwifery, University of West Attica, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Greece
| | | | | | | | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Greece
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HALİMOĞLU B, YEŞİLÇİÇEK ÇALIK K. Sezaryen doğum oranlarında “kıymetli bebek” etkisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.738328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Coussa A, Hasan HA, Barber TM. Early Predictors of Gestational Diabetes Mellitus in IVF-Conceived Pregnancies. Endocr Pract 2020; 27:579-585. [PMID: 34120700 DOI: 10.1016/j.eprac.2020.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/27/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcomes. This study aimed to identify early and reliable GDM predictors that would enable implementation of preventive and management measures. METHODS The participants were a 28-week prospective cohort of in vitro fertilization (IVF)-conceived pregnant women (≤39 years, body mass index [BMI] 18.5-38 kg/m2) without a known history of diabetes mellitus. Fasting blood samples were analyzed at baseline (pre-IVF) and 12 weeks' gestation for reproductive hormones, glucose, serum insulin, lipids, thyroid function, adiponectin, and lipopolysaccharide-binding protein. At 28 weeks, a 75-g oral glucose tolerance test was used to screen for GDM. RESULTS For the overall group at baseline, 22% had BMI ≥30 kg/m2, 45% had polycystic ovary syndrome, 16% had hemoglobin A1C of 5.7% to 6.1%, and 14% had a past history of GDM. At 28 weeks of gestation (n = 158), 34 women had developed GDM and 124 had not. Significant baseline predictors of GDM onset included greater BMI (29.0 vs 25.8 kg/m2), older age (34 vs 32 years), higher levels of follicle-stimulating hormone/luteinizing hormone ratio (1.2 vs 1.0), hemoglobin A1C (5.5 vs 5.2%), insulin (10.6 vs 7.1 μIU/mL), homeostatic model assessment of insulin resistance (2.2 vs 1.7), total cholesterol (199 vs 171 mg/dL), and low-density lipoprotein cholesterol (123 vs 105 mg/dL), and lower triglyceride levels (74 vs 76 mg/dL). Significant 12-week GDM predictors included greater maternal weight gain (delta: 3.4 vs 1.5 kg) and higher levels of insulin (11.3 vs 7.6 μIU/mL), triglycerides (178 vs 120 mg/dL), and homeostatic model assessment of insulin resistance (2.3 vs 1.5). Twelve-week BMI is a predictor of GDM following adjustment for polycystic ovary syndrome status and maternal age. CONCLUSION While preconception maternal BMI, age, and follicle-stimulating hormone/luteinizing hormone ratio are predictors of subsequent development of GDM, early IVF-conceived gestational weight gain is the best predictor of GDM onset.
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Affiliation(s)
- Ayla Coussa
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
| | - Hayder A Hasan
- Department of Clinical Nutrition and Dietetics, University of Sharjah, City University, Muwailih, Sharjah, PO Box 27272, United Arab Emirates
| | - Thomas M Barber
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
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Pan H, Zhang X, Rao J, Lin B, He JY, Wang X, Han F, Zhang J. Comparison of general maternal and neonatal conditions and clinical outcomes between embryo transfer and natural conception. BMC Pregnancy Childbirth 2020; 20:422. [PMID: 32718312 PMCID: PMC7385858 DOI: 10.1186/s12884-020-03066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/17/2020] [Indexed: 11/14/2022] Open
Abstract
Background To examine the differences between pregnant women who underwent embryo transfer (ET) and those who conceived naturally, as well as differences in their respective babies, and to determine the causes for these differences, to provide recommendations for women who are planning to undergo ET. Methods A retrospective cohort study was performed of women who had received ET and those who had natural conception (NC) who received medical services during pregnancy and had their babies delivered at the Shunde Women and Children’s Hospital of Guangdong Medical University, China between January 2016 and December 2018. In line with the requirements of the ethics committee, before the formal investigation, we first explained the content of the informed consent of the patient to the patient, and all the subjects included agreed to the content of the informed consent of the patient. Respondents agreed to visit and analyze their medical records under reasonable conditions. Each case in an ET group of 321 women was randomly matched with three cases of NC (963 cases) who delivered on the same day. The demographic information, past history, pregnancy and delivery history, and maternal and neonatal outcomes of the two groups were compared using univariate analysis. Results Age, duration of hospitalization, number of pregnancies, number of miscarriages, induced abortion, ectopic pregnancy, gestational diabetes mellitus, preeclampsia, gestational anemia, pregnancy risk, mode of fetal delivery, and number of births were significantly different between the two groups (all P < 0.05). However, there were no significant differences in the disease, allergy, infection and blood transfusion histories of the pregnant women, or differences in prevalence of gestational hypothyroidism, gestational respiratory infection, premature rupture of membrane, placental abruption, fetal death, stillbirth, amniotic fluid volume and amniotic fluid clarity between the two groups (all P > 0.05). The percentages for low birth weight and premature birth were significantly higher in the ET group than in the NC group. In contrast, infant gender and prevalence of fetal macrosomia, fetal anomaly, neonatal asphyxia, and extremely low birth weight were not significantly different between the two groups (all P > 0.05). Conclusions The clinical outcomes of mothers and the birth status of infants were better in the NC group than in the ET group. Maternal health must be closely monitored and improved in the ET group to reduce the incidence of gestational comorbidity and enhance the quality of fetal life.
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Affiliation(s)
- Haiyan Pan
- School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong Province, China
| | - Xingshan Zhang
- School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong Province, China
| | - Jiawei Rao
- School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong Province, China
| | - Bing Lin
- Shunde Women and Children's Hospital of Guangdong Medical University, Shunde, 528399, Guangdong Province, China
| | - Jie Yun He
- Shunde Women and Children's Hospital of Guangdong Medical University, Shunde, 528399, Guangdong Province, China
| | - Xingjie Wang
- School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong Province, China
| | - Fengqiong Han
- Shunde Women and Children's Hospital of Guangdong Medical University, Shunde, 528399, Guangdong Province, China.
| | - Jinfeng Zhang
- Shunde Women and Children's Hospital of Guangdong Medical University, Shunde, 528399, Guangdong Province, China.
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Basirat Z, Kashifard M, Golsorkhtabaramiri M, Mirabi P. Factors associated with spontaneous abortion following intracytoplasmic sperm injection (ICSI). JBRA Assist Reprod 2019; 23:230-234. [PMID: 31056891 PMCID: PMC6724394 DOI: 10.5935/1518-0557.20190028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: The aim of this study was to describe the miscarriage rates and the factors
associated with cases of spontaneous abortion observed in women offered
intracytoplasmic sperm injection (ICSI). Methods: This cross-sectional study enrolled women who became pregnant with the aid
of ICSI treated at the Babol Infertility Center (Iran) within a period of
five years (2010-2015). Data were collected from patient charts and, in some
cases, through phone calls. The study looked into the incidence of
spontaneous abortion in women offered ICSI and the factors associated with
miscarriage. The chi-square test, Fisher's exact test, and the t-test were
used to analyze the data. Results: From a total of 145 pregnant women, 120 were included in our study. The
prevalence of miscarriage was 20%. Galactorrhea was significantly more
present in patients who had miscarriages (25% vs. 9.37%,
p=0.04). There was a marked difference in the duration
of infertility of miscarriage and non-miscarriage patients offered ICSI
(6.6±8.3 vs. 4.9±7.3 years,
p=0.05). No association was found between maternal age,
BMI, cause of infertility, hormonal pattern, type of infertility, history of
surgery, polycystic ovary syndrome, number of oocytes, or day of retrieval
with miscarriage.
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Affiliation(s)
- Zahra Basirat
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehdi Kashifard
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Masoumeh Golsorkhtabaramiri
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Parvaneh Mirabi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Kim MS, Kang S, Na ED, Im J, Ahn E, Shin JE, Moon MJ. Obstetrical outcomes of embryo reduction and fetal reduction compared to non-reduced twin pregnancies. Arch Gynecol Obstet 2019; 299:953-960. [PMID: 30826872 DOI: 10.1007/s00404-019-05089-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/02/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To prevent perinatal morbidity and mortality of high-order multiple pregnancy (HOMP), multifetal pregnancy reduction (MPR) is offered to some patients. In this study, we investigated whether twin pregnancies derived from MPRs carry a higher adverse obstetrical outcome compared to non-reduced control group of twins. METHODS We retrospectively analyzed the data from HOMPs on which transvaginal ER (n = 153) at a mean gestational age of 7.6 weeks or transabdominal FR (n = 59) at a mean gestational age of 12.4 weeks was performed between December 2006 and January 2018. The risk of each procedure was evaluated by comparing obstetrical outcome with that of a control population of 157 non-reduced twins conceived by infertility treatment. RESULTS The mean gestational ages at delivery were 35.2 weeks in the ER group, 35.7 weeks in the FR group, and 34.1 weeks in the control group (P = NS). Compared with those in the control group, the ER group had higher miscarriage (1.3% vs. 6.5%; P = 0.047; OR 0.21; 95% CI 0.45-0.898) and higher overall fetal loss (3.8% vs. 14.4%; P = 0.003; OR 0.24; 95% CI 0.09-0.60) rates. Differently compared with those in the control group, the FR group had no statistical difference in miscarriage (2.5% vs. 1.7%; P=NS) and overall fetal loss (3.8% vs. 6.8%; P=NS) rates. CONCLUSIONS Compared with the control group, ER in twins had a higher miscarriage and fetal loss rate, whereas FR in twins was similar to the control group. So, the FR procedure is overall a better and safer approach of MPR in reducing morbidity and mortality in HOMPs.
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Affiliation(s)
- Mi Sun Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13496, Republic of Korea
| | - Sukho Kang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13496, Republic of Korea
| | - Eun Duc Na
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13496, Republic of Korea
| | - Jisun Im
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13496, Republic of Korea
| | - Eunhee Ahn
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13496, Republic of Korea
| | - Ji Eun Shin
- Fertility Center of CHA Bundang Medical Center, 59 Yatap-ro, Seongnam, 13496, Republic of Korea
| | - Myoung Jin Moon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13496, Republic of Korea.
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