FIGO good practice recommendations on reduction of preterm birth in pregnancies conceived by assisted reproductive technologies

Introduction. The number of women with multiple pregnancy is increasing worldwide, especially in countries with a high level of health care, where assisted reproductive technologies are widely used. According to foreign studies, one third of twins are born as a result of Assisted Reproductive Technologies (ART), so only an increase in multiple pregnancy can be predicted in the future. The main obstetric problem with these pregnancies is the problem of carrying.Objective: To identify the predictors of preterm birth in patients with multiple pregnancy in order to improve monitoring and prophylactic measures among this cohort of women.Material and methods: A retrospective controlled observational study, including 154 patients with multiple pregnancies was carried out. Logistic analysis was used to identify the predictors of preterm labour.Results: The study showed that the predictors of preterm birth varied from one trimester to another. Based on the identified predictors, the predictive models for each trimester of pregnancy were compiled. Most of the identified predictors are related to obstetrical history. Risk groups formation, based on the identification of these predictors, is extremely important for qualified medical support. Prophylactic measures should be performed on the pre-conceptional stage. Pregnancy planning should be recommended only after treatment of chronic endometritis, followed by control of vaginal microflora and progesterone support. It is hardly possible to talk about the prevention of cervical insufficiency. However, cervical correction is an important factor for perinatal outcomes improving. The research suggests that the insertion of cervical pessary in women with multiple pregnancy and cervical insufficiency allows to prolong the gestational period for 7 weeks.Conclusion: a comprehensive approach of management of women with multiple pregnancy based on the prognostic scales of preterm labour, allows to reduce the preterm birth rate.

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EPIDEMIOLOGY AND RISK FACTORS FOR PREMATURE BIRTH

Knowledge International Journal ◽

10.35120/kij2802629m ◽

2018 ◽

Vol 28 (2) ◽

pp. 629-636

Author(s):

Anna Mihaylova ◽

Nikoleta Parahuleva ◽

Elina Petkova-Gueorguieva ◽

Stanislav Gueorguiev

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Prenatal Care ◽

Premature Birth ◽

Assisted Reproductive Technologies ◽

Preterm Births ◽

Developed Countries ◽

Reproductive Technologies ◽

Risk Indicators ◽

Etiological Factors

Premature birth is a significant medical, social and economic problem worldwide. In the 21st Century in developed countries, this problem accounts for over two thirds of neonatal deaths. In Bulgaria, statistics show that 10-12% of all pregnancies end with premature birth. Despite the number of studies in this field and the efforts made by obstetricians and gynecologists, the tendency to increase the number of preterm births has continued in the last decade. Its consequences are multiple complications who lead to a high neonatal mortality in the national and global world. Preterm birth is characterized by complex and vague etiology. A specific cause of premature birth can not be defined, but a set of risk factors is considered, divided into three main groups of etiological factors: socio-economic, medical-biological, and behavioral. Associated with preterm birth socio-economic and behavioral risk factors include poverty, unemployment, low education, poor prenatal care, harmful habits such as smoking, alcohol, drugs and other harmful substances, unhealthy family environment, severe and prolonged stress, excessive physical exercise (lifting weights), trauma (hits or violence), new pregnancies less than 6 months after previous birth, unhealthy diet and low mother BMI, etc. Essential for the preterm birth is also the medico - biological etiological factors. One of these is uterine enlargement, as the main reason for this may be the presence of: multiple pregnancies that occurred naturally or after using assisted reproductive technologies or polyhydramnios (increased amount of amniotic fluid). Other risk factors include: placenta previa, incorrect position of the fetus, myoma, uterine cervix malformations (including cerebrovascular insufficiency), preeclampsia, uterine contractions, acute infections during pregnancy (vaginal - chlamydia, trichomonas, mycoplasma , toxoplasmosis, bacterial vaginosis, viral rubella, cytomegalovirus, herpes, influenza, adenovirus infection, chronic diseases (hypertension, cardiovascular diseases, diseases of the lungs, liver or kidney anemia and etc.), genetic factors, previous premature birth, etc. These risk indicators are subject to detailed analysis in the work of a number of authors. To limit preterm births, a number of studies have been conducted to identify and identify the risk factors that are relevant to it. Identifying and recognizing their effects and impact leading to premature birth will significantly reduce the severe health, economic and social consequences as well as reduce the risk of neonatal death. In order to reduce the frequency of preterm births, adequate and specialized prenatal care is essential. They must be individually tailored for each particular case of pregnancy and take into account the complex of risk predispositions.

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Morphological features of the state of fetoplacental complex in women with early preterm birth after assisted reproductive technologies

HEALTH OF WOMAN ◽

10.15574/hw.2016.114.79 ◽

2016 ◽

pp. 79-81

Author(s):

A.S. Mandrykova ◽

Keyword(s):

Preterm Birth ◽

Preterm Delivery ◽

Assisted Reproductive Technologies ◽

Reproductive Technologies ◽

Main Group ◽

Fetal Membranes ◽

Control Group ◽

Premature Rupture ◽

Fetoplacental Complex ◽

Early Preterm Birth

The objective: the study of morphofunctional changes of the fetoplacental complex at 28–33 weeks of gestation in women with early preterm delivery after the application of ART. Patients and methods. We have examined 130 patients whose pregnancy occurred after the use of ART. This is the woman who gave birth at 28–33 weeks of gestation. Of these, 80 women had early premature births in the background premature rupture of fetal membranes, 50 – patients with early preterm delivery and timely rupture of fetal membranes (control group 2). The main group included 4 groups of 20 women with regard to the duration of anhydrous interval: 1.1 – anhydrous interval 5–6 hours (main group 1); 1.2 – anhydrous span 24 hours; 1.3 – anhydrous interval 45–48 hours; 1.4 – anhydrous period 5 days after PRFM. Results. Thus, the results of the research indicate that the main cause of early preterm birth in women after using ART are structural dezorhanization changes of collagen fibers of the connective tissue amnion and chorionic which lead to the appearance of microscopic defects – delamination its surface, causing premature rupture of fetal membranes the launch stage localized focal immediate type hypersensitivity reactions and restructuring epithelial cell membranes. Neutrophil macrophage properties in this case reduced and programmed to perform a cycle of incomplete phagocytosis, which increases the synthesis of inflammatory cytokines in the area of rupture of fetal membranes. Сonclusion. Reduced activity of neutrophils increases the effect of abuse and cytokine balance in favor predictor of early spontaneous labor at 28-33 weeks of gestation. Key words: morphological changes of the fetoplacental complex, early preterm birth, expectant tactics of childbirth.

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Assisted reproductive technologies and birth outcomes: overview of recent systematic reviews

Reproduction Fertility and Development ◽

10.1071/rd04095 ◽

2005 ◽

Vol 17 (3) ◽

pp. 329 ◽

Cited By ~ 50

Author(s):

Carol Bower ◽

Michèle Hansen

Keyword(s):

Preterm Birth ◽

Perinatal Mortality ◽

Birth Outcomes ◽

Birth Defects ◽

Systematic Reviews ◽

Low Birthweight ◽

Assisted Reproductive Technologies ◽

Reproductive Technologies ◽

Sound Studies

Several systematic reviews have been published recently on birth outcomes of infants conceived through assisted reproductive technologies (ART), compared with infants conceived spontaneously. These outcomes include perinatal mortality, preterm birth, low birthweight and birth defects. Methodological limitations of many of the individual studies (including small sample size, potential for bias in ascertainment of outcomes and considering singletons and multiples together) were obviated in these reviews by excluding studies where methods were considered inadequate, by conducting meta-analyses using data from all methodologically sound studies (small and large) and by examining singletons separately. Overall, the reviews indicate few differences between outcomes in ART twins compared with twins conceived spontaneously. However, in singleton ART infants, there are around two-fold increases in risk of perinatal mortality, low birthweight and preterm birth, about a 50% increase in small for gestational age and a 30–35% increase in birth defects, compared with singletons conceived spontaneously. Couples considering ART should be counselled about the increased risk of adverse outcomes. Epidemiologists, in conjunction with clinical and laboratory colleagues, should now focus on large, methodologically sound studies with long-term follow up that seek to identify the reasons for these increased risks and their long-term consequences, whether they are associated with particular technologies and causes of infertility, and how they might be reduced.

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FIGO good practice recommendations on modifiable causes of iatrogenic preterm birth

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.13857 ◽

2021 ◽

Vol 155 (1) ◽

pp. 8-12 ◽

Cited By ~ 1

Author(s):

Catalina M. Valencia ◽

Ben W. Mol ◽

Bo Jacobsson ◽

Joe Leigh Simpson ◽

Jane Norman ◽

...

Keyword(s):

Preterm Birth ◽

Good Practice ◽

Practice Recommendations

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FIGO good practice recommendations on the use of pessary for reducing the frequency and improving outcomes of preterm birth

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.13837 ◽

2021 ◽

Vol 155 (1) ◽

pp. 23-25 ◽

Cited By ~ 1

Author(s):

William A. Grobman ◽

Jane Norman ◽

Bo Jacobsson ◽

Joe Leigh Simpson ◽

Ana Bianchi ◽

...

Keyword(s):

Preterm Birth ◽

Good Practice ◽

Practice Recommendations

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All the right moves: why in utero transfer is both important for the baby and difficult to achieve and new strategies for change

F1000Research ◽

10.12688/f1000research.25923.1 ◽

2020 ◽

Vol 9 ◽

pp. 979

Author(s):

Helena Watson ◽

James McLaren ◽

Naomi Carlisle ◽

Nandiran Ratnavel ◽

Tim Watts ◽

...

Keyword(s):

Preterm Birth ◽

Transfer Process ◽

Assisted Reproductive Technologies ◽

Clinical Care ◽

Multiple Pregnancy ◽

Reproductive Technologies ◽

In Utero ◽

The Uk ◽

The Right ◽

The Impact

The best way to ensure that preterm infants benefit from relevant neonatal expertise as soon as they are born is to transfer the mother and baby to an appropriately specialised neonatal facility before birth (“in utero”). This review explores the evidence surrounding the importance of being born in the right unit, the advantages of in utero transfers compared to ex utero transfers, and how to accurately assess which women are at most risk of delivering early and the challenges of in utero transfers. Accurate identification of the women most at risk of preterm birth is key to prioritising who to transfer antenatally, but the administrative burden and pathway variation of in utero transfer in the UK are likely to compromise optimal clinical care. Women reported the impact that in utero transfers have on them, including the emotional and financial burdens of being transferred and the anxiety surrounding domestic and logistical concerns related to being away from home. The final section of the review explores new approaches to reforming the in utero transfer process, including learning from outside the UK and changing policy and guidelines. Examples of collaborative regional guidance include the recent Pan-London guidance on in utero transfers. Reforming the transfer process can also be aided through technology, such as utilising the CotFinder app. In utero transfer is an unavoidable aspect of maternity and neonatal care, and the burden will increase if preterm birth rates continue to rise in association with increased rates of multiple pregnancy, advancing maternal age, assisted reproductive technologies, and obstetric interventions. As funding and capacity pressures on health services increase because of the COVID-19 pandemic, better prioritisation and sustained multi-disciplinary commitment are essential to maximise better outcomes for babies born too soon.

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Perinatal outcomes of pregnancies conceived by assisted reproductive technologies

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1510632s ◽

2015 ◽

Vol 143 (9-10) ◽

pp. 632-638 ◽

Cited By ~ 2

Author(s):

Tamara Sljivancanin ◽

Olivera Kontic-Vucinic

Keyword(s):

Preterm Birth ◽

Perinatal Mortality ◽

Very Low Birth Weight ◽

Assisted Reproductive Technologies ◽

Perinatal Outcomes ◽

Reproductive Technologies ◽

Perinatal Complications ◽

Very Preterm ◽

Very Preterm Birth ◽

Significant Difference

Introduction. Recent epidemiological studies showed significantly higher incidence of perinatal complications in newborns and women after the use of assisted reproductive technologies (ART). Multiple pregnancies are more frequent after the use of ART. Singleton pregnancies following ART are more prone to preterm birth, low and very low birth weight (LBW and VLBW), small for gestational age (SGA) and perinatal mortality. Objective. The aim of this study was to summarize the results of relevant articles and to evaluate whether the mode of conception is the determining factor for different pregnancy outcomes after assisted and natural conceptions. Methods. Eleven studies were included in this review. The following outcomes were observed: preterm and very preterm birth, SGA, LBW, VLBW, perinatal mortality, admission to neonatal intensive care unit (NICU), and Apgar score (As) ?7 at fifth minute. Qualitative analysis and quantitative assessment were performed. Results. For singletons, odds ratios were 1.794 (95% confidence interval 1.660-1.939) for preterm birth, 1.649 (1.301-2.089) for LBW, 1.265 (1.048-1.527) for SGA. Admission to NICU, As?7 at fifth minute and perinatal mortality showed significantly different frequency after assisted conception. Summary of results for twin gestations showed no significant difference between ART and spontaneous conception for preterm birth (32-36 weeks), very preterm birth (<32 weeks), LBW and VLBW. Conclusion. Analyzed studies showed that infants from ART have significantly worse perinatal outcome compared with natural conception. More observational studies should be conducted in order to establish the exact mechanism leading to more frequent perinatal morbidity and mortality after the use of ART.

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